Follow-up Imaging of Low-Risk Unruptured Intracranial Aneurysms

According to the American Heart Association/American Stroke Association (AHA/ASA) Guidelines,¹ “For patients with unruptured intracranial aneurysms (UIAs) that are managed noninvasively without either surgical or endovascular intervention, radiographic follow-up magnetic resonance angiography (MRA) or CT angiography (CTA) at regular intervals is indicated. The optimal interval and duration of recommended follow-up are uncertain.” The undisputed prerequisite for value-based follow-up imaging of people with occult findings is that the surveillance strategy improves the overall health through disease prevention at the individual level (clinical medicine) or at the population level (public health). In value-based health care, hospitals and physicians are encouraged to improve the overall health and reduce unnecessary costs in an evidence-based way. Value-based care differs from a fee-for-service or capitated approach, in which the driving incentive for hospitals and physicians is often times money. For example, if repeated follow-up imaging studies do not improve health at the individual or population level, the benefits of surveillance do not extend to people but to service providers. In a value-based follow-up strategy, the number of clinical visits, medical tests, and interventions are well in balance with the money spent on improving short-term and long-term health of an individual or population.