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Cost-effectiveness of screening for asymptomatic carotid atherosclerotic disease.

Publication ,  Journal Article
Derdeyn, CP; Powers, WJ
Published in: Stroke
November 1996

BACKGROUND AND PURPOSE: The value of screening for asymptomatic carotid stenosis has become an important issue with the recently reported beneficial effect of endarterectomy. The purpose of this study is to evaluate the cost-effectiveness of using Doppler ultrasound as a screening tool to select subjects for arteriography and subsequent surgery. METHODS: A computer model was developed to simulate the cost-effectiveness of screening a cohort of 1000 men during a 20-year period. The primary outcome measure was incremental present-value dollar expenditures for screening and treatment per incremental present-value quality-adjusted life-year (QALY) saved. Estimates of disease prevalence and arteriographic and surgical complication rates were obtained from the literature. Probabilities of stroke and death with surgical and medical treatment were obtained from published clinical trials. Doppler ultrasound sensitivity and specificity were obtained through review of local experience. Estimates of costs were obtained from local Medicare reimbursement data. RESULTS: A one-time screening program of a population with a high prevalence (20%) of > or = 60% stenosis cost $35130 per incremental QALY gained. Decreased surgical benefit or increased annual discount rate was detrimental, resulting in lost QALYs. Annual screening cost $457773 per incremental QALY gained. In a low-prevalence (4%) population, one-time screening cost $52588 per QALY gained, while annual screening was detrimental. CONCLUSIONS: The cost-effectiveness of a one-time screening program for an asymptomatic population with a high prevalence of carotid stenosis may be cost-effective. Annual screening is detrimental. The most sensitive variables in this simulation model were long-term stroke risk reduction after surgery and annual discount rate for accumulated costs and QALYs.

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Published In

Stroke

DOI

ISSN

0039-2499

Publication Date

November 1996

Volume

27

Issue

11

Start / End Page

1944 / 1950

Location

United States

Related Subject Headings

  • Ultrasonography, Doppler
  • Sensitivity and Specificity
  • Quality-Adjusted Life Years
  • Prevalence
  • Population Surveillance
  • Neurology & Neurosurgery
  • Mass Screening
  • Male
  • Humans
  • Cost-Benefit Analysis
 

Citation

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Derdeyn, C. P., & Powers, W. J. (1996). Cost-effectiveness of screening for asymptomatic carotid atherosclerotic disease. Stroke, 27(11), 1944–1950. https://doi.org/10.1161/01.str.27.11.1944
Derdeyn, C. P., and W. J. Powers. “Cost-effectiveness of screening for asymptomatic carotid atherosclerotic disease.Stroke 27, no. 11 (November 1996): 1944–50. https://doi.org/10.1161/01.str.27.11.1944.
Derdeyn CP, Powers WJ. Cost-effectiveness of screening for asymptomatic carotid atherosclerotic disease. Stroke. 1996 Nov;27(11):1944–50.
Derdeyn, C. P., and W. J. Powers. “Cost-effectiveness of screening for asymptomatic carotid atherosclerotic disease.Stroke, vol. 27, no. 11, Nov. 1996, pp. 1944–50. Pubmed, doi:10.1161/01.str.27.11.1944.
Derdeyn CP, Powers WJ. Cost-effectiveness of screening for asymptomatic carotid atherosclerotic disease. Stroke. 1996 Nov;27(11):1944–1950.

Published In

Stroke

DOI

ISSN

0039-2499

Publication Date

November 1996

Volume

27

Issue

11

Start / End Page

1944 / 1950

Location

United States

Related Subject Headings

  • Ultrasonography, Doppler
  • Sensitivity and Specificity
  • Quality-Adjusted Life Years
  • Prevalence
  • Population Surveillance
  • Neurology & Neurosurgery
  • Mass Screening
  • Male
  • Humans
  • Cost-Benefit Analysis