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Multicenter Randomized Controlled Trial of the Costs and Effects of Noninvasive Diagnostic Imaging in Patients with Peripheral Arterial Disease: The DIPAD Trial

¹ Department of Radiology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
² Department of Epidemiology and Biostatistics, Erasmus MC, Rotterdam, The Netherlands.
³ Department of Radiology, Maastricht University Hospital and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
⁴ Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands.
⁵ Department of Vascular Surgery, St. Catharina Hospital, Eindhoven, The Netherlands.
⁶ Department of Radiology, St. Catharina Hospital, Eindhoven, The Netherlands.
⁷ Department of Vascular Surgery, University Medical Centre, Nijmegen, The Netherlands.
⁸ Department of Radiology, University Medical Centre, Nijmegen, The Netherlands.
⁹ Department of Vascular Surgery, Maastricht University Hospital and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
¹⁰ Department of Health Policy and Management, Harvard School of Public Health, Boston, MA.

OBJECTIVE. The purpose of our study was to compare the costs and effects of three noninvasive imaging tests as the initial imaging test in the diagnostic workup of patients with peripheral arterial disease.

MATERIALS AND METHODS. Of 984 patients assessed for eligibility, 514 patients with peripheral arterial disease were randomized to MR angiography (MRA) or duplex sonography in three hospitals and to MRA or CT angiography (CTA) in one hospital. The outcome measures included the clinical utility, functional patient outcomes, quality of life, and actual diagnostic and therapeutic costs related to the initial imaging test during 6 months of follow-up.

RESULTS. With adjustment for potentially predictive baseline variables, the learning curve, and hospital setting, a significantly higher confidence and less additional imaging were found for MRA and CTA compared with duplex sonography. No statistically significant differences were found in improvement in functional patient outcomes and quality of life among the groups. The total costs were significantly higher for MRA and duplex sonography than for CTA.

CONCLUSION. The results suggest that both CTA and MRA are clinically more useful than duplex sonography and that CTA leads to cost savings compared with both MRA and duplex sonography in the initial imaging evaluation of peripheral arterial disease.

Keywords: aorta • cost-effectiveness analysis • CT angiography • duplex sonography • MR angiography • peripheral arterial disease

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