ED Patients With Dizziness -- MRI Leads to Lower Costs, Higher Cumulative QALYs

Background: Objective: To evaluate the cost-effectiveness of differing neuroimaging methods in the evaluation of patients presenting to the emergency department (ED) with dizziness who are not candidates for acute intervention. Methods: A decision-analytic model was constructed from a health care system perspective for the evaluation of a patient presenting to the ED with dizziness. Four strategies were compared: noncontrast head CT, head and neck CT angiography (CTA), conventional brain MRI, and specialized brain MRI (including multiplanar high-resolution diffusion-weighted imaging). Differing long-term costs and outcomes related (stroke detection and secondary prevention measures) were compared. Cost-effectiveness was calculated in terms of lifetime expenditures in 2022 U.S. dollars for each quality-adjusted life year (QALY). Results: Specialized MRI resulted in the highest QALYs and was the most cost-effective strategy compared with noncontrast head CT. Conventional MRI had the ne more...