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What is the optimal schedule for screening patients at high risk for intracranial aneurysms? To explore this issue, researchers used a Markov model and Monte Carlo simulation to assess screening with magnetic resonance angiography (MRA) for intracranial aneurysms compared with no screening in people with a history of two or more first-degree relatives with aneurysmal subarachnoid hemorrhage (SAH). The authors evaluated various ages for screening initiation (20, 30, or 40) and completion (60, 70, or 80) in combination with screening at various intervals (2, 3, 5, 7, 10, or 15 years apart). The endpoints were quality-adjusted life years (QALYs) and cost.
In the simulation, the most cost-effective strategy (in dollars/QALY) was to screen every …