Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-27T14:58:23.209Z Has data issue: false hasContentIssue false

13 - Cost-effectiveness analysis for carotid imaging

from Luminal imaging techniques

Published online by Cambridge University Press:  03 December 2009

By
Jean Marie U-King-Im ,
William Hollingworth  and
Jonathan H. Gillard
Edited by
Jonathan Gillard ,
Martin Graves ,
Thomas Hatsukami  and
Chun Yuan
Jean Marie U-King-Im
Affiliation:
Addenbrooke's Hospital and the University of Cambridge, UK
William Hollingworth
Affiliation:
University of Washington, Seattle, WA 98103, USA
Jonathan H. Gillard
Affiliation:
Addenbrooke's Hospital and the University of Cambridge, UK
Jonathan Gillard
Affiliation:
University of Cambridge
Martin Graves
Affiliation:
University of Cambridge
Thomas Hatsukami
Affiliation:
University of Washington
Chun Yuan
Affiliation:
University of Washington
Get access

Summary

Introduction

The pooled analysis of data from large randomized trials such as the North American symptomatic carotid trial (NASCET) and the European carotid surgery trial (ECST) has confirmed the significant benefits of surgery for severe (70–99%) carotid stenosis in recently symptomatic patients (Rothwell et al., 2003). Moreover, in asymptomatic patients, 60% stenosis is generally used as a cut-off for surgery based on the results of the asymptomatic carotid atherosclerosis study (ACAS) (Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study, 1995). In most of these trials, intraarterial digital subtraction angiography (DSA) has been used to measure the degree of stenosis and as such, remains the gold standard method in terms of diagnostic accuracy, against which alternative imaging modalities need to be validated. Concerns about the small but potentially significant risks of neurological complications associated with DSA have generated a strong trend toward the use of noninvasive modalities such as Doppler ultrasound (DUS), magnetic resonance angiography (MRA) or computerized tomography angiography (CTA) alone or in combination (Dawson et al., 1997; Athanasoulis and Plomaritoglou, 2000; Long et al., 2002).

In current clinical practice, there is ongoing controversy whether noninvasive strategies can replace DSA as the preoperative imaging modality of choice (Derdeyn and Powers, 1996; Davis and Donnan, 2003). This lack of consensus is reflected by a wide variety of existing practices worldwide (Dawson et al., 1997; Athanasoulis and Plomaritoglou, 2000; Long et al., 2002; Willinsky et al., 2003).

Keywords

asymptomatic carotid atherosclerosisasymptomatic patientscarotid imagingcost-effectiveness decision analysisstenosiseconomic analyses
Type
Chapter
Information
Carotid Disease
The Role of Imaging in Diagnosis and Management
 , pp. 166 - 179
Publisher: Cambridge University Press
Print publication year: 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alvarez-Linera, J., Benito-Leon, J., Escribano, J., Campollo, J. and Gesto, R. (2003). Prospective evaluation of carotid artery stenosis: elliptic centric contrast-enhanced Magnetic resonance angiography and spiral Computerized tomography angiography compared with digital subtraction angiography. AJNR. American Journal of Neuroradiology, 24, 1012–19.Google ScholarPubMed
Athanasoulis, C. A. and Plomaritoglou, A. (2000). Preoperative imaging of the carotid bifurcation. Current trends. International Angiology, 19, 1–7.Google ScholarPubMed
Benade, M. M. and Warlow, C. P. (2002a). Cost of identifying patients for carotid endarterectomy. Stroke, 33, 435–9.CrossRefGoogle Scholar
Benade, M. M. and Warlow, C. P. (2002b). Costs and benefits of carotid endarterectomy and associated preoperative arterial imaging: a systematic review of health economic literature. Stroke, 33, 629–38.CrossRefGoogle Scholar
Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991). New England Journal of Medicine, 325, 445–53.CrossRef
Berry, E., Kelly, S., Westwood, M. E., et al. (2002). The cost-effectiveness of magnetic resonance angiography for carotid artery stenosis and peripheral vascular disease: a systematic review. Health Technology Assessment, 6, 1–155.CrossRefGoogle ScholarPubMed
Blackmore, C. C. and Smith, W. J. (1998). Economic analyses of radiological procedures: a methodological evaluation of the medical literature. European Journal of Radiology, 27, 123–30.CrossRefGoogle ScholarPubMed
Briggs, A. (2005). Probabilistic analysis of cost-effectiveness models: statistical representation of parameter uncertainty. Value Health, 8, 1–2.CrossRefGoogle ScholarPubMed
Briggs, A. H., Goeree, R., Blackhouse, G. and O'Brien, B. J. (2002). Probabilistic analysis of cost-effectiveness models: choosing between treatment strategies for gastroesophageal reflux disease. Medical Decision Making, 22, 290–308.CrossRefGoogle ScholarPubMed
Briggs, A., Sculpher, M. and Buxton, M. (1994). Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. Health Economics, 3, 95–104.CrossRefGoogle ScholarPubMed
Buskens, E., Nederkoorn, P. J., Buijs-Van Der Woude, T., et al. (2004). Imaging of carotid arteries in symptomatic patients: cost-effectiveness of diagnostic strategies. Radiology, 233, 101–12.CrossRefGoogle ScholarPubMed
Chaturvedi, S. (2003). Should the multicenter carotid endarterectomy trials be repeated?Archives of Neurology, 60, 774–5.CrossRefGoogle ScholarPubMed
Chaturvedi, S., Clagett, P., Cote, R., Dillon, W., Findlay, M. and Flack, J. (2004). Intensive carotid artery stenosis treatment trial. Proceedings of the 29th International Stroke Conference.
Cinat, M., Lane, C. T., Pham, H., et al. (1998). Helical Computerized tomography angiography in the preoperative evaluation of carotid artery stenosis. Journal of Vascular Surgery, 28, 290–300.CrossRefGoogle ScholarPubMed
Cohen, M. D. (2001). Determining costs of imaging services. Radiology, 220, 563–5.CrossRefGoogle ScholarPubMed
Cohen, M. D., Hawes, D. R., Hutchins, G. D., et al. (2000). Activity-based cost analysis: a method of analyzing the financial and operating performance of academic radiology departments. Radiology, 215, 708–16.CrossRefGoogle ScholarPubMed
Coull, A. J., Lovett, J. K. and Rothwell, P. M. (2004). Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services. British Medical Journal, 328, 326.CrossRefGoogle ScholarPubMed
Davis, S. M. and Donnan, G. A. (2003). Is carotid angiography necessary? Editors disagree. Stroke, 34, 1819.CrossRefGoogle Scholar
Dawson, D. L., Roseberry, C. A. and Fujitani, R. M. (1997). Preoperative testing before carotid endarterectomy: a survey of vascular surgeons' attitudes. Annals of Vascular Surgery, 11, 264–72.CrossRefGoogle ScholarPubMed
Derdeyn, C. P. and Powers, W. J. (1996). Cost-effectiveness of screening for asymptomatic carotid atherosclerotic disease. Stroke, 27, 1944–50.CrossRefGoogle ScholarPubMed
Detsky, A. S., Naglie, G., Krahn, M. D., Naimark, D. and Redelmeier, D. A. (1997a). Primer on medical decision analysis: Part 1–Getting started. Medical Decision Making, 17, 123–5.CrossRefGoogle Scholar
Detsky, A. S., Naglie, G., Krahn, M. D., Redelmeier, D. A. and Naimark, D. (1997b). Primer on medical decision analysis: Part 2–Building a tree. Medical Decision Making, 17, 126–35.CrossRefGoogle Scholar
Devlin, N. and Parkin, D. (2004). Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis. Health Economics, 13, 437–52.CrossRefGoogle ScholarPubMed
Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study (1995). JAMA: the Journal of the American Medical Association, 273, 1421–8.CrossRef
Fairhead, J. F. and Rothwell, P. M. (2005). The need for urgency in identification and treatment of symptomatic carotid stenosis is already established. Cerebrovascular Diseases, 19, 355–8.CrossRefGoogle ScholarPubMed
Gray, W. A., White, H. J. Jr., Barrett, D. M., et al. (2002). Carotid stenting and endarterectomy: a clinical and cost comparison of revascularization strategies. Stroke, 33, 1063–70.CrossRefGoogle ScholarPubMed
Hankey, G. J. and Warlow, C. P. (1990). Symptomatic carotid ischaemic events: safest and most cost effective way of selecting patients for angiography, before carotid endarterectomy. British Medical Journal, 300, 1485–91.CrossRefGoogle Scholar
Hollingworth, W., Nathens, A. B., Kanne, J. P., et al. (2003). The diagnostic accuracy of computed tomography angiography for traumatic or atherosclerotic lesions of the carotid and vertebral arteries: a systematic review. European Journal of Radiology, 48, 88–102.CrossRefGoogle ScholarPubMed
Kallmes, D. F., Omary, R. A., Dix, J. E., Evans, A. J. and Hillman, B. J. (1996). Specificity of Magnetic resonance angiography as a confirmatory test of carotid artery stenosis. American Journal of Neuroradiology, 17, 1501–6.Google ScholarPubMed
Kent, K. C., Kuntz, K. M., Patel, M. R., et al. (1995). Perioperative imaging strategies for carotid endarterectomy. An analysis of morbidity and cost-effectiveness in symptomatic patients. JAMA: the Journal of the American Medical Association, 274, 888–93.CrossRefGoogle ScholarPubMed
Krahn, M. D., Naglie, G., Naimark, D., Redelmeier, D. A. and Detsky, A. S. (1997). Primer on medical decision analysis: Part 4–Analyzing the model and interpreting the results. Medical Decision Making, 17, 142–51.CrossRefGoogle Scholar
Leclerc, X. and Pruvo, J. P. (2000). Recent advances in magnetic resonance angiography of carotid and vertebral arteries. Current Opinion in Neurology, 13, 75–82.CrossRefGoogle ScholarPubMed
Lee, T. T., Solomon, N. A., Heidenreich, P. A., Oehlert, J. and Garber, A. M. (1997). Cost-effectiveness of screening for carotid stenosis in asymptomatic persons. Annals of Internal Medicine, 126, 337–46.CrossRefGoogle ScholarPubMed
Long, A., Lepoutre, A., Corbillon, E., Branchereau, A. and Kretz, J. G. (2002). Modalities of preoperative imaging of the internal carotid artery used in France. Annals of Vascular Surgery, 16, 261–5.CrossRefGoogle ScholarPubMed
Naglie, G., Krahn, M. D., Naimark, D., Redelmeier, D. A. and Detsky, A. S. (1997). Primer on medical decision analysis: Part 3–Estimating probabilities and utilities. Medical Decision Making, 17, 136–41.CrossRefGoogle Scholar
Naimark, D., Krahn, M. D., Naglie, G., Redelmeier, D. A. and Detsky, A. S. (1997). Primer on medical decision analysis: Part 5–Working with Markov processes. Medical Decision Making, 17, 152–9.CrossRefGoogle ScholarPubMed
Norris, J. W., Morriello, F., Rowed, D. W. and Maggisano, R. (2003). Vascular imaging before carotid endarterectomy. Stroke, 34, E16.CrossRefGoogle ScholarPubMed
Perkins, J. M., Galland, R. B., Simmons, M. J. and Magee, T. R. (2000). Carotid duplex imaging: variation and validation. British Journal of Surgery, 87, 320–2.CrossRefGoogle Scholar
Philips, Z., Ginnelly, L., Sculpher, M., et al. (2004). Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technology Assessment, 8, iii-iv, ix-xi, 1–158.CrossRefGoogle ScholarPubMed
Post, P. N., Stiggelbout, A. M. and Wakker, P. P. (2001). The utility of health states after stroke: a systematic review of the literature. Stroke, 32, 1425–9.CrossRefGoogle ScholarPubMed
Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the Medical research council European Carotid Surgery Trial (European carotid surgery) (1998). Lancet, 351, 1379–87.CrossRef
Randoux, B., Marro, B. and Marsault, C. (2004). Carotid artery stenosis: competition between Computerized tomography angiography and Magnetic resonance angiography. AJNR. American Journal of Neuroradiology, 25, 663–4; author reply 664.Google Scholar
Robless, P. and Halliday, A. (1999). Vascular Surgical Society of Great Britain and Ireland: carotid angiography is used more selectively in the Asymptomatic Carotid Surgery Trial. British Journal Surgery, 86, 690–1.CrossRefGoogle ScholarPubMed
Rothwell, P. M., Eliasziw, M., Gutnikov, S. A., et al. (2003). Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet, 361, 107–16.CrossRefGoogle ScholarPubMed
Rothwell, P. M., Eliasziw, M., Gutnikov, S. A., Warlow, C. P. and Barnett, H. J. (2004). Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet, 363, 915–24.CrossRefGoogle ScholarPubMed
Rothwell, P. M. and Warlow, C. P. (2005). Timing of Transient ischemic attacks preceding stroke: time window for prevention is very short. Neurology, 64, 817–20.CrossRefGoogle ScholarPubMed
Siegel, J. E., Torrance, G. W., Russell, L. B., et al. (1997). Guidelines for pharmacoeconomic studies. Recommendations from the panel on cost effectiveness in health and medicine. Panel on cost Effectiveness in Health and Medicine. Pharmacoeconomics, 11, 159–68.CrossRefGoogle Scholar
Singer, M. E. and Applegate, K. E. (2001). Cost-effectiveness analysis in radiology. Radiology, 219, 611–20.CrossRefGoogle ScholarPubMed
Sonnenberg, F. A. and Beck, J. R. (1993). Markov models in medical decision making: a practical guide. Medical Decision Making, 13, 322–38.CrossRefGoogle ScholarPubMed
U-King-Im, J., Hollingworth, W., Trivedi, R. A., et al. (2005). Cost-effectiveness of diagnostic strategies prior to carotid endarterectomy. Annals of Neurology, 58, 506–15.CrossRefGoogle ScholarPubMed
U-King-Im, J., Hollingworth, W., Trivedi, R. A., et al. (2004a). Contrast-enhanced Magnetic resonance angiography vs intra-arterial digital subtraction angiography for carotid imaging: activity-based cost analysis. European Radiology, 14, 730–5.CrossRefGoogle Scholar
U-King-Im, J., Trivedi, R. A., Graves, M. J., et al. (2004b). Contrast-enhanced Magnetic resonance angiography for carotid disease: diagnostic and potential clinical impact. Neurology, 62, 1282–90.CrossRefGoogle Scholar
Vanninen, R., Manninen, H. and Soimakallio, S. (1995). Imaging of carotid artery stenosis: clinical efficacy and cost-effectiveness. AJNR. American Journal of Neuroradiology, 16, 1875–83.Google ScholarPubMed
Wardlaw, J. M., Chappell, F. M., Stephenson, M., et al. (2006). Accurate, practical and cost-effective assessment of carotid stenosis in the UK. Health Technology Assessment, 10, 1–200.Google Scholar
Weinstein, M. C. and Stason, W. B. (1977). Foundations of cost-effectiveness analysis for health and medical practices. New England Journal of Medicine, 296, 716–21.CrossRefGoogle ScholarPubMed
Willinsky, R. A., Taylor, S. M., Terbrugge, K., et al. (2003). Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology, 227, 522–8.CrossRefGoogle ScholarPubMed
Yadav, J. S., Wholey, M. H., Kuntz, R. E., et al. (2004). Protected carotid-artery stenting versus endarterectomy in high-risk patients. New England Journal of Medicine, 351, 1493–501.CrossRefGoogle ScholarPubMed
Yin, D. and Carpenter, J. P. (1998). Cost-effectiveness of screening for asymptomatic carotid stenosis. Journal of Vascular Surgery, 27, 245–55.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×