Introduction/Purpose Accounting for tens-of-thousands of annual cerebrovascular hospitalizations, the rupture of an intracranial aneurysm (IA) can lead to significant patient morbidity and mortality. Therefore, the early detection of unruptured IAs in high-risk patients can enable life-saving clinical management. Currently, only patients with a strong family history of IAs or those with autosomal dominant polycystic kidney disease are routinely screened for IAs. Another high risk population, however, was identified by our group in a recent study with an elevated detection rate of IAs in female patients of non-Hispanic Black race and Hispanic ethnicity. Targeted screening using magnetic resonance angiography (MRA) in this population could mitigate correspondingly increased IA-related health burdens. The present study sought to determine whether the benefits of MRA screening would be cost-effective in Black and Hispanic female patients.

Materials and Methods Using Markov modeling and cost-effective analysis, we explored the optimal MRA screening strategy for IAs in non-Hispanic Black and Hispanic female patients of 40 to 80 years of age. Clinical and cost parameters were retrieved from our prior studies and through an extensive literature review. Relative to the reference non-screen condition, we computed expected quality adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) for each screening condition (one-time, every 1,3, 5, or 10 years). Further statistical validation for the Markov models was confirmed with sensitivity analyses.

Results Each screening strategy yielded extra QALYs relative to no screen. There was an inverse relationship between QALY gained and frequency of screening (annual, +0.71; every 3y, +0.76; every 5y, +0.77; every 10y, +0.78; single screening, +0.78). Similarly, ICER values decreased with each increasingly frequent screening strategy relative to no screen (annual, $17,282.98 ; every 3y, $6801.70; every 5y, $4,590.49; every 10y, $3,014.74; single screening, $2,628.77).

Conclusion Non-Hispanic Black and Hispanic female patients have been found to have a higher prevalence of intracranial aneurysms than the general population. Across all tested screening strategies, MRA screening for unruptured IAs in this population was found to be cost-effective at a conservative willingness-to-pay threshold of $50,000. While screening once at the age of 40 was found to be the most cost effective, with the lowest ICER, multiple screenings are likely to be supported by best clinical judgment given preserved low cost of screening. Along with previously reported clinical data, the results of this cost-effective analysis, therefore, further support the implementation of regular MRA screening for patients in this high risk population.

Disclosures J. Park: None. J. Reynolds: None. Y. Srivastava: None. N. Haranhalli: None.