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  1. Computer simulation to estimate the effectiveness of carotid endarterectomy.

    Article - En anglais

    Objectives 

    To investigate the benefit of carotid endarterectomy relative to medical treatment, by comparing the outcome for different groups of patients following transient ischaemic attacks.

    Methods 

    A Markov model was used to describe the survival and quality of life of patients treated for a transient ischaemic attack.

    The benefit is measured in terms of quality adjusted life months (QALMs).

    The outcome was estimated using a computer simulation with parameters based on published studies on the probability of events following treatment.

    The benefit of carotid endarterectomy was explored using a baseline set of parameters and a sensitivity analysis.

    Results 

    The baseline scenario of a 65-year-old male patient with the model factors set at an intermediate level showed a benefit for surgery of 3 QALMs compared with medical treatment alone.

    The sensitivity analysis showed that the most favourable combination had a benefit of 13.4 QALMs and the least favourable a loss of 2 QALMs.

    Of all 128 factor combinations, 79.9% showed a benefit for surgery, 5.5% showed equal benefit, and 15.6% showed a benefit for medical treatment.

    Conclusions 

    Computer simulations have the potential for deriving estimates of benefit for different patient groups from the results of clinical trials.

    Combined with reliable information on costs, the technique could also demonstrate variations in cost-effectiveness for these groups. (...)

    Mots-clés Pascal : Efficacité, Evaluation, Méthodologie, Société, Sociologie, Modèle, Epidémiologie, Méthode étude, Appareil circulatoire, Anatomie, Analyse coût efficacité, Sciences économiques, Sensibilité, Validité, Qualité vie, Mode de vie

    Mots-clés Pascal anglais : Efficiency, Evaluation, Methodology, Society, Sociology, Models, Epidemiology, Investigation method, Circulatory system, Anatomy, Cost efficiency analysis, Economics, Sensitivity, Validity, Quality of life, Life habit

    Notice produite par :
    ORS Auvergne - Observatoire Régional de la Santé d'Auvergne

    Code Inist : 002B30A11. Création : 11/09/1998.