Improving the cost-effectiveness of carotid endarterectomy. Discussion.
Annual Meeting of The Southern Association for Vascular Surgery. Coronado (USA), 1997/01/22.
Carotid endarterectomy (CEA) has been shown to significantly reduce the risk of stroke caused by carotid artery stenosis.
Limiting the costs of CEA without increasing the risks will improve the cost-effectiveness of this procedure.
Results were prospectively collected from 63 consecutive CEAs performed in 60 patients who were entered into a clinical pathway for CEA that included avoidance of cerebral arteriography, preferential use of regional anesthesia, selective use of the intensive care unit (ICU), and early hospital discharge.
The mortality rate, complications, hospital costs, and net income in these patients were then compared with results from 45 CEAs performed in 42 consecutive patients immediately before beginning the CEA pathway.
Age, comorbid risk factors, incidence of symptoms, and degree of carotid artery stenosis were similar in both patient groups.
The rates of mortality and complications associated with CEA were low (mortality rate, 0% ; stroke, 0.9% ; transient ischemic attack, 2.8%) and did not vary between the two groups.
Implementation of the CEA pathway resulted in significant (p<0.001) reductions in the use of arteriography (74% to 13%), general anesthesia (100% to 24%), ICU use (98% to 30%), and mean hospital length of stay (5.8 days to 2.0 days).
These changes resulted in a 41% reduction in mean total hospital cost ($9652 to $5699) and a 124% increase in mean net hospital income ($1804 to $4039) per CEA (p<0.01). (...)
Mots-clés Pascal : Endartériectomie, Carotide, Analyse coût efficacité, Sténose, Accident cérébrovasculaire, Traitement, Prévention, Complication, 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, Stroke, Treatment, Prevention, Complication, Human, Surgery, Health economy, Nervous system diseases, Cerebral disorder, Cerebrovascular disease, Cardiovascular disease, Vascular disease, Arterial disease, Central nervous system disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0519174
Code Inist : 002B25J01. Création : 13/02/1998.