Carotid Stenting Versus Endarterectomy in Symptomatic Patients with ≥50% Stenosis: Cost-Effective Options in Patients Aged <70 and ≥70 Years

오성희; 박지정; 이자연; 전평; 조용필; 김태선; 김병문; 박현선; 신상진

추천

검색

자료유형: 학술저널

저자정보: 오성희 박지정 이자연 전평 조용필 김태선 김병문 박현선 신상진

저널정보: 한국보건의료기술평가학회 보건의료기술평가 보건의료기술평가 제7권 제2호

발행연도: 2019.1

수록면: 126 - 133 (8page)

이용수

📌

연구주제

📖

연구배경

🔬

연구방법

🏆

연구결과

초록· 키워드

오류제보하기

The Carotid Revascularization Endarterectomy versus Stenting Trial showed that the relative efficacy of carotid artery stenting (CAS) and carotid endarterectomy (CEA) differs according to patient age. We assessed the cost-effectiveness of CAS vs. CEA in patients aged <70 years and ≥70 years with symptomatic stenosis ≥50%. Methods: Cost-effectiveness analysis was conducted using a Markov model over a lifetime from the Korean healthcare system perspective. Clinical effectiveness was estimated based on a multi-center retrospective cohort study. Costs were calculated using resource use and national health insurance claims data. Health utility weight was assessed using survey data. Results: In the base-case analysis, quality-adjusted life-years (QALYs) for CAS and CEA were 6.49 and 6.71, respectively. The incremental cost of CAS was $1536 compared with CEA. CEA was dominated option in patients with symptomatic stenosis ≥50%. However, in patients aged <70 years, CAS cost $411 less while increasing QALYs by 0.27; in patients aged ≥70 years, CAS cost $3392 more and decreased QALYs by 0.64. Probabilistic sensitivity analyses indicated that CAS would be a cost-effective option in 90.3% of patients aged <70 years and in 7.6% of patients aged ≥70 years. Conclusion: Patient age should be considered when deciding on treatment option for symptomatic stenosis. We believe that CEA would be a cost-effective option in patients aged ≥70 years, whereas CAS could be preferred in patients aged <70 years.

참고문헌 (36)

참고문헌 신청

Gurm HS / 2008 / Long-term results of carotid stenting versus endarterectomy in high-risk patients / N Engl J Med 358:1572~1579

Rothwell PM / 2003 / Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis / Lancet 361:107~116

Brott TG / 2011 / ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery / Circulation 124:e54~e130

International Carotid Stenting Study investigators / 2010 / Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis(International Carotid Stenting Study) : an interim analysis of a randomised controlled trial / Lancet 375:985~997

Eckstein HH / 2008 / Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy(SPACE)study to treat symptomatic stenoses at 2years : a multinational, prospective, randomised trial / Lancet Neurol 7:893~902

함께 읽어보면 좋을 논문

논문 유사도에 따라 DBpia 가 추천하는 논문입니다. 함께 보면 좋을 연관 논문을 확인해보세요!