Contrast MRA beats DSA costs in peripheral vascular disease diagnosis

The Veterans Affairs system could have saved more than $13 million in six years by using contrast-enhanced MR angiography instead of digital subtraction angiography for imaging of peripheral vascular disease, according to a recent study.

Investigators presented findings on almost 20,000 patients at the 2006 International Society of Pharmacoeconomics and Outcomes Research meeting Oct. 31 in Copenhagen.

Clinicians and institutions must be aware of the savings potential of many treatment and imaging modalities in an era of cost containment. Although additional research is needed, data show that using CE-MRA as the initial imaging modality for a substantial proportion of patients provides optimum patient care and considerable cost savings, said principal investigator J.W. Hay, Ph.D., an associate professor of pharmaceutical economics and policy at the University of Southern California in Los Angeles.

"We were impressed with the magnitude of cost savings available with CE-MRA in these patients," Hay said.

Hay and colleagues retrospectively reviewed VA outpatient data from 1999 to 2004. A total of 16,026 patients underwent DSA versus 3183 receiving CE-MRA during this period. The investigators found that use of CE-MRA reduced imaging costs by 55% over DSA, costing $950 or less per imaging procedure than DSA.

Clinicians were more likely to choose CE-MRA for patients with prior renal disease or bypass surgery and less likely to use it for patients with prior amputation, PVD, claudication, or other cardiovascular disease markers. Ninety-two percent of MRA patients required no additional procedures and experienced no events at 30 days, compared with 82% of DSA patients.

Seventy-six percent of MRA patients had no additional interventions or events at 90 days following the initial procedure, compared with 65% of DSA patients. Fewer than 3.2% of all patients underwent new imaging at 30 days, and only 3.6% of all patients required a repeat procedure at 90 days.

Thirty-day treatment costs per patient were $3500 to $4300 lower (p<0.001) for CE-MRA patients, even after adjusting for the choice of initial imaging modality. The researchers concluded that the VA system could have realized a cost savings of $13.2 million during the six-year period if they had chosen CE-MRA over DSA for patients not requiring or planning follow-up procedures within 30 days.

The study, Cost impact of diagnostic imaging of lower extremity peripheral vascular disease (PVD), was conducted by a team of researchers from the VA Cooperative Studies, VA Boston Healthcare System, Harvard Medical School, the University of Southern California, and Berlex Laboratories.

For more information from the Diagnostic Imaging archives:

CT, MR edge ultrasound in PVD utility, but CT wins on cost

Bolus chasing improves peripheral MR angiography

Cost of peripheral CTA compares favorably with MRA