Cost-effectiveness of Carotid Surgery
| Autor: | Pilar Carrasco, Jose A. Gonzalez-Fajardo, Manuel Doblas, Sandra Vicente Jiménez, Juan Fontcuberta, Gil Rodriguez, Angel Flores, Antonio Orgaz, Manuel Maynar |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Cost effectiveness Cost-Benefit Analysis medicine.medical_treatment Carotid endarterectomy 030204 cardiovascular system & hematology Asymptomatic 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine medicine Humans Carotid Stenosis Prospective Studies Hospital Costs Prospective cohort study Aged Endarterectomy Asymptomatic Diseases Aged 80 and over Endarterectomy Carotid business.industry Endovascular Procedures fungi General Medicine Middle Aged medicine.disease Surgery Quality-adjusted life year Stenosis Models Economic Outcome and Process Assessment Health Care Treatment Outcome Spain Quality of Life Female Stents Quality-Adjusted Life Years medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Annals of Vascular Surgery. 57:177-186 |
| ISSN: | 0890-5096 |
| DOI: | 10.1016/j.avsg.2018.09.013 |
| Popis: | Background The purpose of this study is to determinate the cost-effectiveness of carotid endarterectomy (CEA) versus transfemoral stenting (TFS) and transcervical stenting (TCS) in a short- and long-term basis in symptomatic and asymptomatic patients. Methods From January 2003 to December 2014, patients from the vascular department, with symptomatic or asymptomatic carotid stenosis, who were clinically and anatomically suitable for TFS, TCS, or CEA, were included. Prospective cost data for each individual procedure and complication during follow-up were obtained from the diagnosis-related group. The quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios were estimated. Analysis of data was by treatment received. All statistical tests were two-sided. The significance level was 5%. Results A total of 349 patients were enrolled: 61 for CEA (17.5%), 159 for TFS (45.5%), and 129 for TCS (37%). A total of 220 (63%) patients were symptomatic and 129 (37%) were asymptomatic. The median procedural cost and overall cost were lower on CEA (5499€ and 5595€, respectively). However, QALYs, for symptomatic patients, were better on TCS (7.3), whereas for asymptomatic patients, QALYs were better on CEA (9.6). Cost-effectiveness for symptomatic patients was better with TCS (803€/QALY), and for asymptomatic patients, it was with CEA (654€/QALY). Conclusions TFS and TCS were associated with clinical outcomes equivalent to CEA on both symptomatic and asymptomatic patients. Cost-effectiveness ratios for symptomatic patients were better on TCS, whereas the CEA showed the best results in asymptomatic patients. |
| Databáze: | OpenAIRE |
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