Cost-effectiveness of diagnostic strategies prior to carotid endarterectomy.
The main objective of this study was to assess the long-term cost-effectiveness of five alternative diagnostic strategies for identification of severe carotid stenosis in recently symptomatic patients. A decision-analytical model with Markov transition states was constructed. Data sources included a...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
2005
|
| _version_ | 1826282469809192960 |
|---|---|
| author | U-King-Im, J Hollingworth, W Trivedi, R Cross, J Higgins, N Graves, M Gutnikov, S Kirkpatrick, P Warburton, E Antoun, N Rothwell, P Gillard, J |
| author_facet | U-King-Im, J Hollingworth, W Trivedi, R Cross, J Higgins, N Graves, M Gutnikov, S Kirkpatrick, P Warburton, E Antoun, N Rothwell, P Gillard, J |
| author_sort | U-King-Im, J |
| collection | OXFORD |
| description | The main objective of this study was to assess the long-term cost-effectiveness of five alternative diagnostic strategies for identification of severe carotid stenosis in recently symptomatic patients. A decision-analytical model with Markov transition states was constructed. Data sources included a prospective study involving 167 patients who had screening Doppler ultrasound (DUS), confirmatory contrast-enhanced magnetic resonance angiography (CEMRA) and confirmatory digital subtraction angiography (DSA), individual patient data from the European Carotid Surgery Trial and other published clinical and cost data. A "selective" strategy, whereby all patients receive DUS and CEMRA (only proceeding to DSA if the CEMRA is positive and the DUS is negative), was most cost-effective. This was both the cheapest imaging and treatment strategy (35,205 dollars per patient) and yielded 6.1590 quality-adjusted life years (QALYs), higher than three alternative imaging strategies. Probabilistic sensitivity analysis demonstrated that there was less than a 10% probability that imaging with either DUS or DSA alone are cost-effective at the conventional 50,000 dollars/QALY threshold. In conclusion, DSA is not cost-effective in the routine diagnostic workup of most patients. DUS, with additional imaging in the form of CEMRA, is recommended, with a strategy of "CEMRA and selective DUS review" being shown to be the optimal imaging strategy. |
| first_indexed | 2024-03-07T00:44:20Z |
| format | Journal article |
| id | oxford-uuid:84197359-5727-4d41-9ba2-4a2bada9f413 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T00:44:20Z |
| publishDate | 2005 |
| record_format | dspace |
| spelling | oxford-uuid:84197359-5727-4d41-9ba2-4a2bada9f4132022-03-26T21:48:52ZCost-effectiveness of diagnostic strategies prior to carotid endarterectomy.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:84197359-5727-4d41-9ba2-4a2bada9f413EnglishSymplectic Elements at Oxford2005U-King-Im, JHollingworth, WTrivedi, RCross, JHiggins, NGraves, MGutnikov, SKirkpatrick, PWarburton, EAntoun, NRothwell, PGillard, JThe main objective of this study was to assess the long-term cost-effectiveness of five alternative diagnostic strategies for identification of severe carotid stenosis in recently symptomatic patients. A decision-analytical model with Markov transition states was constructed. Data sources included a prospective study involving 167 patients who had screening Doppler ultrasound (DUS), confirmatory contrast-enhanced magnetic resonance angiography (CEMRA) and confirmatory digital subtraction angiography (DSA), individual patient data from the European Carotid Surgery Trial and other published clinical and cost data. A "selective" strategy, whereby all patients receive DUS and CEMRA (only proceeding to DSA if the CEMRA is positive and the DUS is negative), was most cost-effective. This was both the cheapest imaging and treatment strategy (35,205 dollars per patient) and yielded 6.1590 quality-adjusted life years (QALYs), higher than three alternative imaging strategies. Probabilistic sensitivity analysis demonstrated that there was less than a 10% probability that imaging with either DUS or DSA alone are cost-effective at the conventional 50,000 dollars/QALY threshold. In conclusion, DSA is not cost-effective in the routine diagnostic workup of most patients. DUS, with additional imaging in the form of CEMRA, is recommended, with a strategy of "CEMRA and selective DUS review" being shown to be the optimal imaging strategy. |
| spellingShingle | U-King-Im, J Hollingworth, W Trivedi, R Cross, J Higgins, N Graves, M Gutnikov, S Kirkpatrick, P Warburton, E Antoun, N Rothwell, P Gillard, J Cost-effectiveness of diagnostic strategies prior to carotid endarterectomy. |
| title | Cost-effectiveness of diagnostic strategies prior to carotid endarterectomy. |
| title_full | Cost-effectiveness of diagnostic strategies prior to carotid endarterectomy. |
| title_fullStr | Cost-effectiveness of diagnostic strategies prior to carotid endarterectomy. |
| title_full_unstemmed | Cost-effectiveness of diagnostic strategies prior to carotid endarterectomy. |
| title_short | Cost-effectiveness of diagnostic strategies prior to carotid endarterectomy. |
| title_sort | cost effectiveness of diagnostic strategies prior to carotid endarterectomy |
| work_keys_str_mv | AT ukingimj costeffectivenessofdiagnosticstrategiespriortocarotidendarterectomy AT hollingworthw costeffectivenessofdiagnosticstrategiespriortocarotidendarterectomy AT trivedir costeffectivenessofdiagnosticstrategiespriortocarotidendarterectomy AT crossj costeffectivenessofdiagnosticstrategiespriortocarotidendarterectomy AT higginsn costeffectivenessofdiagnosticstrategiespriortocarotidendarterectomy AT gravesm costeffectivenessofdiagnosticstrategiespriortocarotidendarterectomy AT gutnikovs costeffectivenessofdiagnosticstrategiespriortocarotidendarterectomy AT kirkpatrickp costeffectivenessofdiagnosticstrategiespriortocarotidendarterectomy AT warburtone costeffectivenessofdiagnosticstrategiespriortocarotidendarterectomy AT antounn costeffectivenessofdiagnosticstrategiespriortocarotidendarterectomy AT rothwellp costeffectivenessofdiagnosticstrategiespriortocarotidendarterectomy AT gillardj costeffectivenessofdiagnosticstrategiespriortocarotidendarterectomy |