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  1. Is carotid endarterectomy cost-effective ? An analysis of symptomatic and asymptomatic patients.

    Article, Communication - En anglais

    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

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 97-0013599

    Code Inist : 002B17C. Création : 21/05/1997.