@misc{10481/110937,
year = {2013},
month = {1},
url = {https://hdl.handle.net/10481/110937},
abstract = {Background: The aim of this study was to model the cost-effectiveness of carotid endarterectomy for asymptomatic stenosis versus medical therapy based on 10-year data from the Asymptomatic Carotid Surgery Trial (ACST).
Methods: This was a cost-utility analysis based on clinical effectiveness data from the ACST with UK-specific costs and stroke outcomes. A Markov model was used to calculate the incremental cost-effectiveness ratio (ICER, or cost per additional quality-of-life year) for a strategy of early endarterectomy versus medical therapy for the average patient and published subgroups. An exploratory analysis considered contemporary event rates.
Results: The ICER was £7584 per additional quality-adjusted life-year (QALY) for the average patient in the ACST. At thresholds of £20,000 and £30,000 there was a 74 and 84 per cent chance respectively of early endarterectomy being cost-effective. The ICER for men below 75 years of age was £3254, and that for men aged 75 years or above was £71,699. For women aged under 75 years endarterectomy was less costly and more effective than medical therapy; for women aged 75 years or more endarterectomy was less effective and more costly than medical therapy. At contemporary perioperative event rates of 2·7 per cent and background any-territory stroke rates of 1·6 per cent, early endarterectomy remained cost-effective.
Conclusion: In the ACST, early endarterectomy was predicted to be cost-effective in those below 75 years of age, using a threshold of £20,000 per QALY. If background any-territory stroke rates fell below 1 per cent per annum, early endarterectomy would cease to be cost-effective.},
organization = {England Mary Dunhill Fellowship},
organization = {Circulation Foundation Mary Davies Fellowship},
organization = {Vascutek, Renfrew, UK},
publisher = {Wiley},
keywords = {Costs},
keywords = {Effectiveness},
keywords = {Endarterectomy},
title = {Modelling the cost-effectiveness of carotid endarterectomy for asymptomatic stenosis},
doi = {10.1002/bjs.8960},
author = {Thapar, Ankur and García Mochón, Leticia and Epstein, D. and Shalhoub, J. and Davies, A. H.},
}