Cost-effectiveness of endarterectomy in patients with asymptomatic carotid artery stenosis.
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 euros (311,133 euros) and 58,930 euros (779,776 euros) 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.


CONCLUSIONS
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.
Henriksson
M
M
Centre for Medical Technology Assessment, Linköping University, Linköping, Sweden. martin.henriksson@ihs.liu.se
Lundgren
F
F
Carlsson
P
P
D000368:Aged; D016893:Carotid Stenosis / Q000191:economics / Q000601:surgery*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016894:Endarterectomy, Carotid / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D020521:Stroke / Q000191:economics / Q000517:prevention & control