title: 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.
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 long-term 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.
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany. Electronic address: Thomas.luebke@uk-koeln.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Luebke
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Brunkwall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases / Q000401:mortality; D016893:Carotid Stenosis / Q000401:mortality* / Q000628:therapy*; D003131:Combined Modality Therapy / Q000401:mortality / Q000706:statistics & numerical data; D003198:Computer Simulation; D016894:Endarterectomy, Carotid / Q000401:mortality*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D020521:Stroke / Q000401:mortality*; D016903:Drug Monitoring
chemical_list: D005343:Fibrinolytic Agents
keywords: Adherence; Best medical therapy; Carotid endarterectomy; Microsimulation; Stroke