Modelling the cost‐effectiveness of carotid endarterectomy for asymptomatic stenosis. BJS 2013; 100: 231-239.

Published: 23rd November 2012

Authors: A. Thapar, L. Garcia Mochon, D. Epstein, J. Shalhoub, A. H. Davies

Background

The aim of this study was to model the cost‐effectiveness of carotid endarterectomy for asymptomatic stenosis versus medical therapy based on 10‐year data from the Asymptomatic Carotid Surgery Trial (ACST).

Method

This was a cost–utility analysis based on clinical effectiveness data from the ACST with UK‐specific costs and stroke outcomes. A Markov model was used to calculate the incremental cost‐effectiveness ratio (ICER, or cost per additional quality‐of‐life year) for a strategy of early endarterectomy versus medical therapy for the average patient and published subgroups. An exploratory analysis considered contemporary event rates.

Results

The ICER was £ 7584 per additional quality‐adjusted life‐year (QALY) for the average patient in the ACST. At thresholds of £ 20 000 and £ 30 000 there was a 74 and 84 per cent chance respectively of early endarterectomy being cost‐effective. The ICER for men below 75 years of age was £ 3254, and that for men aged 75 years or above was £ 71 699. For women aged under 75 years endarterectomy was less costly and more effective than medical therapy; for women aged 75 years or more endarterectomy was less effective and more costly than medical therapy. At contemporary perioperative event rates of 2·7 per cent and background any‐territory stroke rates of 1·6 per cent, early endarterectomy remained cost‐effective.

Conclusion

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. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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