OBJECTIVES: To present a model of decision and cost-effectiveness analysis that allows assessing the trade-off between the short-term risks of performing a carotid endarterectomy and the rate of preventable future events and the impact of real-world adherence of best medical treatment on cost-effectivenss of both therapeutic options. METHODS: We used data from current literature to define values for a base case and perform a sensitivity analysis. The primary endpoint was a comparison of the fatal and disabling @entity64 -free survival during a 5-year period in a cohort of hypothetical @entity1 who presented asymptomatic severe @entity543 and were treated with either prophylactic carotid endarterectomy or adherent and non-adherent best medical treatment, respectively. RESULTS: The difference in estimated fatal and disabling @entity64 -free survival favoring endarterectomy in @entity1 with asymptomatic severe @entity543 is 44 days over the course of 5 years in case of non-adherent best medical treatment. Over a 5-year time horizon, prophylactic @entity787 would be cost-effective in 50.8% of bootstrap replicates and non-persistent BMT might be economically dominant in 11.1%. The probability that @entity787 would be cost-effective at a willingness-to-pay threshold of @entity7634 50 000/QALY gained was 71.8 %. In 17.9 % prophylactic @entity787 would be more costly and effective than persistent BMT, but its @entity10679 was greater than the WTP, so persistent BMT would be optimal. CONCLUSIONS: In this model, in case of real-world drug adherence it was likely that a strategy of early endarterectomy might be a cost-effective or even the dominant therapeutic option in comparison with a strategy of medical therapy alone (deferred surgery). If background any-territory @entity64 rates on contemporary medical therapy would fall substantially below 0.7 per cent, surgery would cease to be cost-effective.   .

Impact of real-world adherence with best medical treatment on cost-effectiveness of carotid endarterectomy for asymptomatic XXXX .

@entity1 :: ('9606', 'Species') :: ['patients'] @entity64 :: ('MESH:D020521', 'Disease') :: ['stroke'] @entity787 :: ('1084', 'Gene') :: ['CEA'] @entity10679 :: ('1390', 'Gene') :: ['ICER'] @entity543 :: ('MESH:D016893', 'Disease') :: ['carotid stenosis'] @entity7634 :: ('9319', 'Species') :: ['Euro']
@entity543 :: (MESH:D016893,Disease) :: ['carotid artery stenosis']
