This presentation is part of: Poster Session - CEA: Methods and Applications; Health Services Research
VALUE OF INFORMATION IN CAROTID REVASCULARISATION
M P Janssen and E. Buskens. University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
PURPOSE: Stenting of the arteria carotis interna (CAS) for treatment of carotid stenosis is increasingly applied. Costs of stents are high and conclusive trials to determine the (cost-) effectiveness of CAS as compared to endarterectomy (CEA) have to be awaited. The latter was clearly proven effective in symptomatic patients with severe stenosis. In absence of sound evidence and a yet increasing tendency to perform CAS we set out to assess uncertainty regarding costs and clinical outcomes of CAS, determine conditions required for CAS to become cost-effective in the Netherlands and find main targets for further research given the available evidence. METHODS: Cost and effect estimates from various sources were combined in a Markov model. The European Carotid Surgery Trial (ECST) data form the basis for this model. Procedural costs were collected in-house, and late event costs and quality of life estimates were obtained from literature. Estimates for the clinical outcome after carotid stenting were obtained by expert opinion elicitation. The EVPI of several (combinations of) model parameters were calculated to assess their relevance. RESULTS: The costs of CAS were €1.500 higher than those of CEA. Net Health Benefits (at €25.000 per QALY) per percent decrease in complications for CAS were estimated at €2.400, €1.600 and €720 for the rates of peri-operative complications “major stroke”, “minor stroke” and “death” respectively. For long-term postoperative major and minor stroke rates these figures were €9.300 and €3.000. The global EVPI was estimated at €2400 and the EVPI for peri-operative and long-term complication rates were €1600 and €1700 respectively. CONCLUSIONS: At a global EVPI of €2400 an annual intervention rate of approximately 1200 interventions implies a total value of €3.000.000 per year for the Netherlands. Looking at the EVPI of peri-operative and post-operative complications it is clear that even if perfect information on peri-operative complications is obtained, there is still €1.000.000 per year left for research on postoperative complications. A value of sample information analysis may provide a definite answer as to the cost-effectiveness of a randomized trail with long term follow-up.
