This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Cost‐effectiveness of endarterectomy in patients with asymptomatic carotid artery stenosis. BJS 2008; 95: 714-720.
Published: 16th April 2008
Authors: M. Henriksson, F. Lundgren, P. Carlsson
Background
Long‐term health outcomes and costs are important when deciding whether a strategy of carotid endarterectomy in addition to best medical management should be recommended for patients with asymptomatic carotid artery stenosis. This study investigated the cost‐effectiveness of such a strategy compared with a strategy of best medical management alone.
Method
Based on data from the randomized Asymptomatic Carotid Surgery Trial (ACST), a national vascular database and other published sources, expected costs and health outcomes in terms of quality‐adjusted life years (QALYs) of both treatment strategies were estimated using decision‐analytical modelling. Cost‐effectiveness was established for a Swedish setting from a societal perspective.
Results
Base‐case analysis showed that the incremental cost per QALY of a strategy with carotid endarterectomy for 65‐ and 75‐year‐old men (women) was €34 557 (€311 133) and €58 930 (€779 776) respectively. Sensitivity analyses indicated that the duration of the treatment effect after 5 years of follow‐up in the ACST was important for the cost‐effectiveness results.
Conclusion
Carotid endarterectomy in addition to best medical management can be considered cost‐effective in men aged 73 years or less but is less likely to be cost‐effective in older men or in women. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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