Is carotid endarterectomy cost-effective ? An analysis of symptomatic and asymptomatic patients.
Council on Cardio-Thoracic and Vascular Surgery. American Heart Association. Scientific Sessions. Anaheim, California (USA), 1995/11/13.
Background The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the Asymptomatic Carotid Atherosclerosis Study (ACAS) showed significant risk reductions for carotid endarterectomy (CE) but did not consider the cost-effectiveness of CE.
Methods and Results We developed Markov models based on NASCET and ACAS to simulate hypothetical cohorts of patients with carotid stenosis and calculated quality-adjusted life expectancies and direct medical costs for those receiving either CE or medical therapy.
For symptomatic patients, we used a surgical stroke risk of 5.8%, a 2-year stroke risk of 27.6% for medical patients, and a post-30-day surgical risk reduction of 87% for ipsilateral strokes.
For symptom-free patients, we used a surgical stroke risk of 1.7%, a 5-year stroke risk of 17.5% for medical patients, and a post-30-day surgical risk reduction of 74% for ipsilateral strokes.
Cost and quality-of-life estimates were estimated from the literature.
The incremental cost-effectiveness ratio of CE versus medical therapy was $4100 and $52 700 per quality-adjusted life year (QALY) gained for symptomatic and symptom-free patients, respectively.
Incremental cost-effectiveness ratios were<$50 000/QALY gained for symptomatic patients for wide variations in baseline assumptions. (...)
Mots-clés Pascal : Sténose, Carotide, Endartériectomie, Analyse coût efficacité, Economie santé, Traitement, 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, Cost efficiency analysis, Health economy, Treatment, Human, Nervous system diseases, Cerebral disorder, Cerebrovascular disease, Cardiovascular disease, Vascular disease, Arterial disease, Central nervous system disease, Surgery
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Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0013599
Code Inist : 002B17C. Création : 21/05/1997.