Cost-effectiveness of endarterectomy in patients with asymptomatic carotid artery stenosis in Sweden
2008 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 95, no 6, 714-720 p.Article in journal (Refereed) Published
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.
Methods: 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.
Place, publisher, year, edition, pages
Chichester, West Sussex, United Kingdom: John Wiley & Sons, 2008. Vol. 95, no 6, 714-720 p.
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-14661DOI: 10.1002/bjs.6157ISI: 000258391500009OAI: oai:DiVA.org:liu-14661DiVA: diva2:24160