Cost-effectiveness of screening for asymptomatic carotid stenosis.
Annual Meeting of The Society for Vascular Surgery. Boston, MA, USA, 1997/06/01.
Pulpose : The benefit of carotid endarterectomy for patients who are asymptomatic with>60% carotid stenosis has been established by the Asymptomatic Carotid Atherosclerosis Study (ACAS).
Which screening strategy is most appropriate is still unclear.
This study assessed the cost-effectiveness of ultrasound screening for asymptomatic carotid stenosis.
Cost-effectiveness analysis was performed with a Markov model and with data from ACAS and other studies.
For 60-year-old patients with a 5% prevalence of 60% to 99% asymptomatic stenosis, duplex ultrasound screening increased average quality-adjusted life years (QALY ; 11.485 vs 11.473) and lifetime cost of care ($5500 vs $5012) under base-case assumptions.
The incremental cost per QALY gained (cost-effectiveness ratio) was $39,495.
Screening was cost-effective with the following conditions : disease prevalence was 4.5% or more, the specificity of the screening test (ultrasound) was 91% or more, the stroke rate of patients who were medically treated was 3.3% or more, the relative risk reduction of surgery was 37% or more, the stroke rate associated with surgery was 160% or less than that of the North American Symptomatic Carotid Endarterectomy Trial or ACAS perioperative complication rates, and the cost of ultrasound screening was $300 or less.
A one-time screening, compared with a screening every 5 years, had more QALY (11.485 vs 11.482) and lower cost ($5500 vs $5790). (...)
Mots-clés Pascal : Sténose, Carotide, Vieillard, Homme, Asymptomatique, Dépistage, Coût, Echodopplérométrie, Economie santé, Système nerveux pathologie, Encéphale pathologie, Cérébrovasculaire pathologie, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Artère pathologie, Système nerveux central pathologie, Exploration ultrason, Imagerie médicale
Mots-clés Pascal anglais : Stenosis, Carotid, Elderly, Human, Asymptomatic, Medical screening, Costs, Duplex ultrasonography, Health economy, Nervous system diseases, Cerebral disorder, Cerebrovascular disease, Cardiovascular disease, Vascular disease, Arterial disease, Central nervous system disease, Sonography, Medical imagery
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0217238
Code Inist : 002B30A03A. Création : 11/09/1998.