Cost-effectiveness analysis of MRA screening for cerebral aneurysms in Black and Hispanic women: A high risk population

Abstract

BackgroundUnruptured intracranial aneurysms (UIAs) are dilations of major brain arteries, affecting 3% to 5% of adults globally. Prior studies have identified women of Black race and/or Hispanic ethnicity as a high-risk population for UIAs. The clinical utility of early identification and treatment of UIAs is well established, however the economic impact of standardized screening protocols remains unclear. This study aimed to evaluate the cost-effectiveness of magnetic resonance angiography (MRA) screening for UIAs in this high risk population of patients aged 40 to 80 years, hypothesizing that such screening would be beneficial and cost-effective.Materials and methodsA Markov decision analytic model was used to compare various MRA screening frequencies against no screening for UIAs. Clinical and cost parameters were obtained from literature, focusing on the target population. The model computed quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) for different screening strategies.ResultsAll screening strategies increased QALYs compared to no screening. Single screening at age 40 provided the highest QALY gain (+0.79) with the lowest ICER ($2052.27). More frequent screenings yielded higher costs without proportionate QALY gains. Sensitivity analysis indicated that MRA cost and UIA prevalence had the greatest impact on ICER.ConclusionMRA screening for UIAs in non-Hispanic Black and Hispanic female patients is cost-effective, particularly with a single screening at age 40. This strategy improves health outcomes and provides the best cost-effectiveness ratio, supporting its implementation for high-risk populations.

Keywords: MRA screening cost-effectiveness; Markov model for aneurysm screening; QALYs and ICER in UIA detection; high-risk aneurysm screening strategies.

Figure 1.

This decision tree shows how patients flow through Markov model.

Figure 2.

This graph shows the incremental effectiveness (QALY) versus incremental costs (USD) for different screening strategies.

Figure 3.

This is a tornado diagram that shows the sensitivity of different parameters on the ICER for no screen versus one screen.

Figure 4.

Budget impact analysis.