Universität zu Köln

Luebke, Thomas and Brunkwall, Jan (2016). Impact of Real-World Adherence with Best Medical Treatment on Cost-Effectiveness of Carotid Endarterectomy for Asymptomatic Carotid Artery Stenosis. Ann. Vasc. Surg., 30. S. 236 - 248. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1615-5947

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Abstract

Background: To present a model of decision and cost-effectiveness analysis that allows assessing the trade-off between the short-term risks of performing a carotid endarterectonny (CEA) and the rate of preventable future events and the impact of real-world adherence of best medical treatment (BMT) on cost-effectiveness of both therapeutic options. Methods: We used data from the current literature to define values for a base case and perform a sensitivity analysis. The primary end point was a comparison of the fatal and disabling stroke-free survival during a 5-year period in a cohort of hypothetical patients who presented asymptomatic severe carotid stenosis and were treated with either prophylactic CEA or adherent and nonadherent best medical treatment, respectively. Results: The difference in estimated fatal and disabling stroke-free survival favoring endarterectomy in patients with asymptomatic severe carotid stenosis is 44 days over the course of 5 years in case of nonadherent best medical treatment. Over a 5-year time horizon, prophylactic CEA would be cost-effective in 50.8% of bootstrap replicates and nonpersistent BMT might be economically dominant in 11.1%. The probability that CEA would be cost-effective at a willingness-to-pay (WTP) threshold of Euro 50,000/quality-adjusted life year gained was 71.8%. In 17.9% prophylactic CEA would be more costly and effective than persistent BMT, but its incremental cost-effectiveness ratio was greater than the WTP, so persistent BMT would be optimal. Conclusions: In this model, in case of real-world drug adherence, it was likely that a strategy of early endarterectomy might be a cost-effective or even the dominant therapeutic option in comparison with a strategy of medical therapy alone (deferred surgery). If background any-territory stroke rates on contemporary medical therapy would fall substantially below 0.7%, surgery would cease to be cost-effective.

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:38-291920
DOI:	10.1016/j.avsg.2015.06.098
Journal or Publication Title:	Ann. Vasc. Surg.
Volume:	30
Page Range:	S. 236 - 248
Date:	2016
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1615-5947
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language STROKE; RISK; DISEASE; SURGERY; ANESTHESIA; PREVENTION; OUTCOMES; EVENTS Multiple languages Surgery; Peripheral Vascular Disease Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/29192