Universität zu Köln

Luebke, Thomas and Brunkwall, Jan (2016). Development of a Microsimulation Model to Predict Stroke and Long-Term Mortality in Adherent and Nonadherent Medically Managed and Surgically Treated Octogenarians with Asymptomatic Significant Carotid Artery Stenosis. World Neurosurg., 92. S. 513 - 523. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1878-8769

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Abstract

BACKGROUND: The primary study objective was to develop a microsimulation model to predict preventable first-ever and recurrent strokes and mortality for a population of medically or surgically managed octogenarians with substantial (>60%) asymptomatic carotid artery stenosis and comparing an adherent with a real-world nonadherent best medical treatment (BMT) regimen subjected to sex. METHODS: A Monte Carlo microsimulation model was constructed with a 14-year time horizon and with 10,000 patients. Probabilities and values for clinical outcomes were obtained from the current literature. RESULTS: The stratification of the microsimulation estimates by treatment strategy within the female group of octogenarians showed a statistically significant lower stroke rate during follow-up for carotid endarterectomy (CEA) compared with nonadherent BMT (P < 0.0001) as well as compared with adherent BMT (P < 0.0001). In male octogenarians, the CEA strategy was also associated with statistically significant lower stroke rates compared with adherent and nonadherent BMT (P < 0.0001 and P < 0.0001, respectively). For each treatment strategy, female octogenarians had a statistically significant longer overall longterm survival compared with male octogenarians (P < 0.0001, respectively). In terms of stratification by sex, in octogenarian men and women, long-term survival was significantly better for adherent BMT compared with nonadherent BMT, and CEA was associated with a significant better long-term survival compared with nonadherent BMT. CONCLUSIONS: In the present microsimulation, in real-world drug adherence, it was likely that a strategy of early endarterectomy was beneficial in octogenarians with significant asymptomatic carotid artery disease compared with BMT alone.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Luebke, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Brunkwall, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-267449
DOI:	10.1016/j.wneu.2016.05.034
Journal or Publication Title:	World Neurosurg.
Volume:	92
Page Range:	S. 513 - 523
Date:	2016
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1878-8769
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language COST-EFFECTIVENESS; VASCULAR EVENTS; SEX-DIFFERENCES; HIGH-RISK; ENDARTERECTOMY; DISEASE; PREVENTION; CANCER; OUTCOMES; STATINS Multiple languages Clinical Neurology; Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/26744