Cost-effectiveness analysis in diagnosis of renal artery stenosis according to different decision makers

Purpose: To examine ?cost- effectiveness analysis? which is not commonly used in daily practice yet important in terms of health economy from a radiologist?s point of view, to provide awareness of improved programmes concerning the subject and to form an opinion about how to use it in the diagnostic arena. For this purpose, the results from the ?renal artery stenosis? model obtained through cost-effectiveness analysis are evaluated.Materials and Methods: TreeAge Software, which is deemed suitable for modeling, was obtained through internet and used. Doppler Ultrasound, CT-Angiography, MR- Angiography and inter-arterial angiography were determined for the diagnostic evaluation of Renal Artery Stenosis. Diagnostic and therapeutical course and recovery stages of the disease were evaluated. Decision tree analysis, Markov Modeling and Monte Carlo simulation models were used for cost-effectiveness analysis and the results were evaluated seperately in perspectives of the patient (insured, uninsured), the payer and the provider. Cost-Effectiveness Ratio, incremental Cost-Effectiveness Ratio and nephropathy-free survival year were used as efectiveness criteria.Results: Similar results were obtained from decision tree analysis, Monte Carlo simulation and Markov Modeling with the same perspective approaches. According to this, concerning the approach of the patient insured perspective, CT-Angiography and IA DSA are eliminated by decision tree analysis, Monte Carlo simulation and Markov Modeling while Doppler US and MR- Angiography are preferable cost- effective alternatives depending on decision maker?s budget. Similar results were obtained from the approach of the patient uninsured and the provider perspectives. In the approach of the payer perspective MR- Angiography and IA DSA are eliminated while Doppler US and CT-Angiography are preferable cost- effective alternatives depending on decision maker?s budget.Conclusion: Cost- effectiveness analysis is one of the subjects that decision makers can benefit from and radiologists should learn about it due to its increasing importance. Appropriate computer softwares are deveoped in order to perform the analyses. It is easy to perform the analyses when the data concerning sensitivity, specificity and the cost are known. The analyses help the investigators plan the decision process better and it can be pointed out what the decisions made mean to different points of view.Key words: Renal artery stenosis, Cost-effectiveness analysis, Decision tree analysis, Markov modeling, Monte Carlo Simulation.