Abstract

Purpose

Despite ongoing debate about best practices for managing incidentally detected findings in brain research studies using magnetic resonance imaging (MRI), this issue has not been investigated from a health economics viewpoint. We applied a decision-analytic approach to assess the benefit of various strategies for functional MRI (fMRI) studies using intracranial aneurysms (IA) as a model.

Methods

A decision tree and Markov model were created to simulate the impact on the lifetime costs and quality-adjusted life-years (QALY) of four different strategies for review of scans for the presence of IA. To populate the decision model, we used current evidence from the literature and results from a survey of experts.

Results

Review of the anatomical scans by a nonspecialist is not cost-effective in any of the subgroups of participants. Full clinical examination of women with a positive family history before enrollment in a study is cost-effective. Cost-effectiveness of reviewing scans obtained from women without a family history and men with a positive family history of IA depends on the willingness-to-pay (λ) for a QALY: at λ of $50,000/QALY, review of scans by a specialist is cost-effective, whereas at λ of $100,000/QALY, a full clinical workup is the best option. Compared with not reviewing any scans, a customized strategy for each subgroup of participants results in an incremental cost-effectiveness ratio of $12,503 for λ = $50,000/QALY and $32,767 for λ = $100,000/QALY.

Conclusion

Tailored strategies based on the characteristics of research participants and λ for one QALY are needed to address the problem of incidental findings in research fMRI studies.