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.