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  1. Cost-effectiveness of carotid endarterectomy in asymptomatic patients. Discussion.

    Article, Communication - En anglais

    International Society for Cardiovascular Surgery. North American Chapter. Scientific Meeting. Chicago, Ill, (USA), 1996/06/09.

    Purpose 

    The purpose of this study was to determine the cost-effectiveness of carotid endarterectomy for treating asymptomatic patients with<60% internal carotid stenosis, based on outcomes reported in the Asymptomatic Carotid Atherosclerosis Study (ACAS).

    Methods 

    A cost-effectiveness analysis was performed using a Markov decision model in which the probabilities for base-case analysis (average age, 67 years ; 66% male ; perioperative stroke plus death rate, 2.3% ; ipsilateral stroke rate during medical management, 2.3% per year) were based on ACAS.

    The model assumed that patients who had TIAs or minor strokes during medical management crossed over to surgical treatment, and used the NASCET data to model the outcome of these now-symptomatic patients.

    Average cost of surgery ($8500), major stroke ($34,000 plus $18,000 per year), and other costs were based on local cost determinations plus a review of the published literature.

    Cost-effectiveness was calculated as the incremental cost of surgery per quality-adjusted life year (QALY) saved when compared with medical treatment, discounting at 5% per year.

    Sensitivity analysis was performed to determine the impact of key variables on cost-effectiveness.

    Results 

    In the base-case analysis, surgical treatment improved quality-adjusted life expectancy from 7.87 to 8.12 QALYs, at an incremental lifetime cost of $2041. (...)

    Mots-clés Pascal : Endartériectomie, Carotide, Analyse coût efficacité, Sténose, Asymptomatique, Traitement, Homme, Chirurgie, Economie santé, Système nerveux pathologie, Encéphale pathologie, Cérébrovasculaire pathologie, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Artère pathologie, Système nerveux central pathologie

    Mots-clés Pascal anglais : Endarteriectomy, Carotid, Cost efficiency analysis, Stenosis, Asymptomatic, Treatment, Human, Surgery, Health economy, Nervous system diseases, Cerebral disorder, Cerebrovascular disease, Cardiovascular disease, Vascular disease, Arterial disease, Central nervous system disease

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

    Cote : 97-0237222

    Code Inist : 002B25J01. Création : 11/06/1997.