OBJECTIVES : Vascular disease(VD) is an important disease with a high mortality rate when diagnosed late. Magnetic resonance imaging(MR) with Gadobutrol(GAD), MR with Gadoteric Acid(GOT) and peripheral angiography(PA) methods are used in the diagnosis of VD in Turkey. The aim of the study was to compare the clinical and economic outcomes of alternative imaging methods in the diagnosis of vascular disease.

METHODS : The clinical and economic differences of GAD MR, GOT MR and PA were examined through a literature review. An expert opinion survey conducted for the missing data. The data analyzed via the decision tree model. In case of no diagnosis with GAD; it is modeled that MR contrast imaging applied with GOT; or vice versa. PA was performed in cases in which diagnoses could not be made using both agents with MRI. Annexes of reimbursement guidelines of Social Security Institution(SSI); Annex 2/B, Annex 2/C, Annex 3/H, and Annex 4/A were used for cost calculations.

RESULTS : According to literature, the sensitivity rate for GAD and GOT was 83% and 68%, the specificity rate was 94% and 90%, respectively. The cost per patient with the diagnosis was calculated via a decision tree as 245 TL for GAD and 251 TL for GOT. On the other hand, 7% less PA was needed in the GAD which avoids 29% less unnecessary treatment and serves 9% less time need to diagnosis compared to GOT. In addition, GAD arm serves relatively 69% of less mortality with better and faster diagnosis compared to GOT.

CONCLUSIONS : As a result of the analysis via the decision tree model; GAD offered more favorable cost, a higher rate of correct diagnosis and fewer patients who needed PA. Decision-makers are required to perform holistic analyses based on the cost of additional diagnosis or treatment; not on the unit's costs of the products.