Perioperative imaging strategies for carotid endarterectomy : an analysis of morbidity and cost-effectiveness in symptomatic patients.
- To assess the cost-effectiveness of four diagnostic strategies for the preoperative evaluation of symptomatic patients who are potential candidates for carotid endarterectomy (ie, 70% to 99% stenosis) : (1) duplex sonography (DS), (2) magnetic resonance angiography (MRA), (3) contrast angiography (CA), and (4) the combination of DS and MRA supplemented by CA for disparate results.
- Cost-effectiveness analysis based largely on published clinical trial data.
Sensitivities and specificities of noninvasive tests were estimated from 81 patients undergoing prospective evaluation with DS, MRA, and CA.
- Incremental cost per quality-adjusted year of life gained.
- For a hypothetical cohort of symptomatic patients undergoing evaluation for carotid endarterectomy, the combination of tests resulted in the greatest quality-adjusted life expectancy of the four options considered.
After incorporating the costs of testing, surgery, and stroke, we found that neither the MRA nor the CA strategy was cost-effective.
- Our results suggest that for the preoperative detection of a 70% to 99% carotid stenosis, the combination of DS and MRA is associated with the lowest long-term morbidity and mortality and has a favorable cost-effectiveness ratio.
The combination of tests could potentially replace the current practice of using CA alone in the preoperative evaluation of patients with symptomatic carotid stenosis.
Mots-clés Pascal : Sténose, Carotide, Endartériectomie, Imagerie médicale, Préopératoire, Diagnostic, Economie santé, Technique, Exploration, Homme, Système nerveux pathologie, Encéphale pathologie, Cérébrovasculaire pathologie, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Artère pathologie, Système nerveux central pathologie, Chirurgie
Mots-clés Pascal anglais : Stenosis, Carotid, Endarteriectomy, Medical imagery, Preoperative, Diagnosis, Health economy, Technique, Exploration, Human, Nervous system diseases, Cerebral disorder, Cerebrovascular disease, Cardiovascular disease, Vascular disease, Arterial disease, Central nervous system disease, Surgery
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0551741
Code Inist : 002B24B04. Création : 01/03/1996.