Developing methodologies to evaluate benefits and costs of Arterial Spin Labeling in Alzheimer's Disease

We developed a methodology to perform an economic evaluation of the Arterial Spin Labeling (ASL) MRI technology in the diagnosis of Alzheimer's Disease. The evaluation was designed to inform about the potential of this new technology in generating benefits while controlling costs. After surveying all relevant literature and data, we set up a decision model based on a Markov cycle tree and applied it to compare costs and benefits of four different diagnostic strategies: “PET”, “MRI-DSC”, “MRI-ASL” and “No Exam”. By using available input data from diverse studies and by taking, when it existed, Portuguese data, the model allowed us to calculate incremental cost-effectiveness ratios between the different diagnosis strategies. Although the model is sensitive to MRI-ASL cost, to MRI-ASL performance values or to the treatment time span, we found evidence for MRI-ASL to be the dominating strategy, being cost effective in comparison to all concurrent strategies, even when the uncertainty for several parameters is taken into account by using a Monte Carlo simulation method.