Background and Purpose The value of screening for asymptomatic carotid stenosis has become an important issue with the recently reported beneficial effect of endarterectomy.
The purpose of this study is to evaluate the cost-effectiveness of using Doppler ultrasound as a screening tool to select subjects for arteriography and subsequent surgery.
Methods A computer model was developed to simulate the cost-effectiveness of screening a cohort of 1000 men during a 20-year period.
The primary outcome measure was incremental present-value dollar expenditures for screening and treatment per incremental present-value quality-adjusted life-year (QALY) saved.
Estimates of disease prevalence and arteriographic and surgical complication rates were obtained from the literature.
Probabilities of stroke and death with surgical and medical treatment were obtained from published clinical trials.
Doppler ultrasound sensitivity and specificity were obtained through review of local experience.
Estimates of costs were obtained from local Medicare reimbursement data.
Results A one-time screening program of a population with a high prevalence (20%) of =60% stenosis cost $35 130 per incremental QALY gained.
Decreased surgical benefit or increased annual discount rate was detrimental, resulting in lost QALYs.
Annual screening cost $457 773 per incremental QALY gained.
In a low-prevalence (4%) population, one-time screening cost $52588 per QALY gained, while annual screening was detrimental. (...)
Mots-clés Pascal : Athérosclérose, Sténose, Carotide, Asymptomatique, Diagnostic, Imagerie médicale, Coût spécifique, Economie santé, Endartériectomie, Dopplérométrie, Evaluation performance, Indication, Exploration, Homme, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Système nerveux pathologie, Encéphale pathologie, Cérébrovasculaire pathologie, Artère pathologie, Système nerveux central pathologie, Chirurgie, Exploration ultrason
Mots-clés Pascal anglais : Atherosclerosis, Stenosis, Carotid, Asymptomatic, Diagnosis, Medical imagery, Specific cost, Health economy, Endarteriectomy, Doppler ultrasound study, Performance evaluation, Indication, Exploration, Human, Cardiovascular disease, Vascular disease, Nervous system diseases, Cerebral disorder, Cerebrovascular disease, Arterial disease, Central nervous system disease, Surgery, Sonography
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0015744
Code Inist : 002B12B01. Création : 21/05/1997.