Cost-effective Evaluation and Treatment for Carotid Disease

Ballard, Jeffrey L.; Deiparine, Michael K.; Bergan, John J.; Bunt, T.J.; Killeen, J. David; Smith, Louis L.

doi:10.1001/archsurg.1997.01430270054011

Cited by 21 publications

(11 citation statements)

References 21 publications

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“…35e37 Most evaluations (17 studies) were costeutility analyses, 20e23,25e29,31e38 two were cost-effectiveness analyses 39,40 and four studies were cost-minimisation analyses. 18,19,24,30 With respect to the model type, 14 studies used Markov models, 20,22,25e28,31e38 two studies used unclassified decision-analytic models, 21,23 and seven studies used ODAs. 18,19,24,29,30,39,40 Two of the ODAs were randomised controlled trials.…”

Section: Resultsmentioning

confidence: 99%

“…The standard pre-operative imaging is the carotid angiogram (AG), and there were five studies that compared potential alternatives with AG. 18,19,24,25,37 Potential comparators were 'US','AG', 'MRA', 'computed tomography angiography' (CTA), and the combined strategies 'US þ CTA','US þ MRA' and 'US þ MRA supplemented with AG'. There was no strong evidence for any of the pairwise comparisons, as the evidence in none of the studies was based on RCTs.…”

Section: Economic Evaluation Of Cea Supporting Proceduresmentioning

confidence: 99%

See 1 more Smart Citation

Limited Economic Evidence of Carotid Artery Stenosis Diagnosis and Treatment: A Systematic Review

Shenoy¹,

Aljutaili²,

Stollenwerk

2012

European Journal of Vascular and Endovascular Surgery

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Section: Resultsmentioning

confidence: 99%

Section: Economic Evaluation Of Cea Supporting Proceduresmentioning

confidence: 99%

Limited Economic Evidence of Carotid Artery Stenosis Diagnosis and Treatment: A Systematic Review

Shenoy¹,

Aljutaili²,

Stollenwerk

2012

European Journal of Vascular and Endovascular Surgery

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“…20,21 The cost of CEA was reported in pounds sterling in the unpublished studies 27,28 , but a reference financial year was not specified. A cost of £3300 per CEA was reported using retrospective data, 28 and the cost of CEA based on the Healthcare Resource Group cost was estimated be- 8 Dardik et al 11 Mellissano et al 9 Kraiss et al 15 Garrard et al 16 Pollard et al 13 Ballard et al 12 Ammar 14 Year ECU indicates European currency unit; ICU, intensive care unit; LOHS, length of hospital stay; CPT, current procedural terminology; DRG, diagnosis-related group; "new" practice, duplex only, no catheter angiogram regional anesthesia; selective use ICU; early discharge; n.m., not mentioned; n.a., not applicable.…”

Section: Costingmentioning

confidence: 99%

Costs and Benefits of Carotid Endarterectomy and Associated Preoperative Arterial Imaging

Benade

Warlow

2002

Stroke

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Background and Purpose-Carotid endarterectomy (CEA) reduces the risk of stroke in patients with severe stenosis of the internal carotid artery. However, the cost implications of this procedure have not yet been satisfactorily addressed. The objective of this systematic review was to critically appraise the studies addressing the economic implications of CEA and the associated preoperative arterial imaging. Methods-A systematic search strategy was developed to identify research articles related to the economic evaluation of CEA and the associated preoperative imaging. MEDLINE, EMBASE, and BIOSIS were electronically searched, and reference lists from identified studies were searched manually. Methods used to critically appraise these studies followed proposed guidelines for an economic evaluation that addresses 10 distinct aspects under 3 separate headings. Results-Studies identified were either partial economic or full economic evaluations, with the majority coming from the United States. The methodological quality seems to have improved over time. The studies that assessed costeffectiveness of CEA were all modeling studies; although the same baseline parameters were used, divergent conclusions were reached. Variation in the cost estimates of CEA ($9500 to $11 500) in the same health care system was also observed in the studies reporting only on the cost of carotid surgery. For a symptomatic patient, the benefit of CEA ranged from 0.35 quality adjusted life years (QALYs) (4.2 months) at a cost of $4100 per QALY to 0.93 QALYs (11.2 months) at a cost of $434 per QALY. For an asymptomatic patient, the cost-effectiveness of CEA varied from 0.15 QALYs (1.8 months) at a cost of $52 700 per QALY to 0.25 QALYs (3 months) at a cost of $8004 per QALY. Conclusions-Divergent conclusions of the cost-effectiveness of CEA were reported from studies that addressed the same questions and using similar parameters in their models. The cost estimates of the procedure and the different time periods used in the studies might explain these inconsistencies. Modeling studies in hypothetical cohorts might also be to blame. The cost-effectiveness of CEA will only definitively be assessed when real patient data are used. (Stroke. 2002;33:629-638.)

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“…A number of studies addressed the cost of CEA itself, but the results are not readily transferable to other settings. 5,6,8,9,[12][13][14][15][16][17][18][19][20][21][22] Only one study, 4 in which the cost of investigating patients before CEA was described, referred to the "program" cost to the National Health Service and concluded that current available data sources are unsatisfactory. Although it would have been ideal to have reported the cost of CEA from our prospective cost analysis study in this article, much of the detail of the cost analysis would have been lost, or it would have resulted in superficial reporting on a very detailed investigation.…”

Section: Benade and Warlow What Does Carotid Endarterectomy Really Comentioning

confidence: 99%

Cost of Identifying Patients for Carotid Endarterectomy

Benade

Warlow

2002

Stroke

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Background and Purpose-The cost of carotid endarterectomy (CEA) usually considers only the cost of the preoperative investigations and the procedure for the individual patient but ignores the cost incurred in selecting a patient from a referred "pool" of potential candidates or the "total direct program cost." The aim of this study was to estimate the total direct program cost (workup and procedure) of CEA in a large major teaching hospital in Edinburgh, Scotland using a retrospective study design. Methods-Participants were patients with transient ischemic attacks and mild strokes referred to the neurovascular clinics for assessment, investigation, and possible CEA. The "workup" was defined as the clinical consultation, carotid duplex, 1 follow-up visit, and a catheter angiogram where indicated. We used data routinely collected from the neurovascular clinics during a 1-year period to estimate the workup cost of patients who might be suitable for CEA. The CEA procedure cost was estimated prospectively in a concurrent study. Estimated costs were applied to the proportions assessed at the different levels of investigation to determine the total direct program cost of CEA. Results-A total of 790 new patients with symptoms suggestive of transient ischemic attacks and mild strokes were identified. Four hundred one (51%) patients were referred for carotid duplex. Duplex identified 78 (10%) with carotid stenosis of Ն70%. Of the total of 790 patients, 26 (3.3%) had catheter angiogram and 18 (2.3%) had CEA. The total direct program cost to investigate this cohort was about £207 000, with 68% (£140 000) of the cost incurred before any surgery was performed. Conclusion-The cost of identifying suitable patients for carotid surgery is quite high, with more than 30% of the cost attributed to the initial consultation at the neurovascular clinics. The cost of preventing 1 stroke by CEA is in the region of £100 000 at 1997/1998 prices if all the costs incurred in the workup of a cohort for potential CEA are included.

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Cost-effective Evaluation and Treatment for Carotid Disease

Abstract: The addition of carotid arteriography to a diagnostic Duplex ultrasound study that already suggested the need for CEA did not change the operative plan in 98% (162/165) of the cases. Carotid endarterectomy based solely on DU is appropriate and cost-effective.

Cited by 21 publications

References 21 publications

Limited Economic Evidence of Carotid Artery Stenosis Diagnosis and Treatment: A Systematic Review

Limited Economic Evidence of Carotid Artery Stenosis Diagnosis and Treatment: A Systematic Review

Costs and Benefits of Carotid Endarterectomy and Associated Preoperative Arterial Imaging

Cost of Identifying Patients for Carotid Endarterectomy

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