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  1. Cost-effectiveness of screening for asymptomatic carotid stenosis.

    Article, Communication - En anglais

    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.

    Methods 

    Cost-effectiveness analysis was performed with a Markov model and with data from ACAS and other studies.

    Results 

    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

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

    Cote : 98-0217238

    Code Inist : 002B30A03A. Création : 11/09/1998.