Modelling the cost-effectiveness of carotid endarterectomy for asymptomatic stenosis

Thapar, Ankur; Mochón, Leticia García; Epstein, David; Shalhoub, Joseph; Davies, Alun H.

doi:10.1002/bjs.8960

Cited by 12 publications

(5 citation statements)

References 32 publications

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“…differences amounted to significant improvements in the efficacy of CEA. These differences roughly equate to the additional QALYs gained from performing CEA for asymptomatic carotid stenosis 36,37 or symptomatic 50e69%…”

Section: Discussionmentioning

confidence: 99%

Do Integrated Systems of Stroke Care Improve Symptom to Surgery Times in Patients with Symptomatic Carotid Stenosis? A Single Centre Decision Tree Analysis

Mofidi

Thomas

Wong

et al. 2018

European Journal of Vascular and Endovascular Surgery

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Section: Discussionmentioning

confidence: 99%

Do Integrated Systems of Stroke Care Improve Symptom to Surgery Times in Patients with Symptomatic Carotid Stenosis? A Single Centre Decision Tree Analysis

Mofidi

Thomas

Wong

et al. 2018

European Journal of Vascular and Endovascular Surgery

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“…34,35 This is reflected by UK national statistics, which report that of 5543 CEA patients during a 1-year period, 4818 (87%) were symptomatic, whereas only 725 (13%) were asymptomatic. 42 Thapar et al 14 provide high-quality evidence demonstrating the UK cost-effectiveness of asymptomatic CEA over conservative treatment for individuals younger than 75 years. This is supported by studies from Sweden 43 and the United States, with data suggesting that >80% of CEAs performed in the United States are asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…High-quality studies. The lifetime cost-utility of early asymptomatic CEA vs medical therapy was modeled by Thapar et al 14 with a 74% chance of early CEA being cost-effective at a £20,000 threshold. These model predictions remained consistent if the cost of the procedure rose by 50%.…”

Section: Ceamentioning

confidence: 99%

The role of cost-effectiveness for vascular surgery service provision in the United Kingdom

Mandavia

Dharmarajah

Qureshi

et al. 2015

Journal of Vascular Surgery

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There is strong economic evidence for symptomatic superficial venous intervention. However, funding for varicose vein treatments remains controversial. Future economic analyses are required for symptomatic and asymptomatic CEA to better advise national policy. Despite strong economic evidence, current UK guidance is for EVAR over open repair in the elective setting, with the majority of elective AAA repairs being EVAR.

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“…The main assumptions are listed in Table S1. The model was adapted from a previous model 10 and was reported in accordance with the CHEERS checklist 11 .…”

Section: Model Structurementioning

confidence: 99%

Cost-effectiveness of carotid endarterectomy in symptomatic patients

Pérez-Troncoso

Epstein

Davies

et al. 2022

British Journal of Surgery

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Background Medical therapy for stroke prevention has improved significantly over the past 30 years. Recent analyses of medically treated cohorts have suggested that early rates of stroke may have reduced, and reports of the safety of carotid surgery have also shown improvements. Since the effectiveness of carotid surgery versus medical therapy was established in the 1990s, there is an urgent need to evaluate whether surgery remains cost-effective in the UK. Methods A decision model was developed to estimate the lifetime costs and utilities of modern medical therapy with and without carotid endarterectomy in patients with symptomatic stenosis from the perspective of the UK National Health Service. The base-case population consisted of adults aged 70 years with 70–99 per cent stenosis. Model data were obtained from clinical studies and wider literature. Univariate and probabilistic sensitivity analyses were carried out. Results In the base-case scenario, the 5-year absolute risk reduction with carotid endarterectomy was 5 per cent, and the incremental cost-effectiveness ratio was €12 021 (exchange rate £1 GBP = €1.1125 (Tuesday 1 January 2019)) per quality-adjusted life-year. Surgery was more cost-effective if performed rapidly after presentation. In patients with 50–69 per cent carotid stenosis, surgery appeared less clinically effective. However, there was considerable uncertainty. Conclusion Surgery may not now be clinically effective and cost-effective in those with moderate carotid stenosis. However, these results are uncertain because of the limited data on modern medical therapy and an RCT may be justified.

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Modelling the cost-effectiveness of carotid endarterectomy for asymptomatic stenosis

Abstract: In the ACST, early endarterectomy was predicted to be cost-effective in those below 75 years of age, using a threshold of £20,000 per QALY. If background any-territory stroke rates fell below 1 per cent per annum, early endarterectomy would cease to be cost-effective.

Cited by 12 publications

References 32 publications

Do Integrated Systems of Stroke Care Improve Symptom to Surgery Times in Patients with Symptomatic Carotid Stenosis? A Single Centre Decision Tree Analysis

Do Integrated Systems of Stroke Care Improve Symptom to Surgery Times in Patients with Symptomatic Carotid Stenosis? A Single Centre Decision Tree Analysis

The role of cost-effectiveness for vascular surgery service provision in the United Kingdom

Cost-effectiveness of carotid endarterectomy in symptomatic patients

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