Abstract WP404: Cost-Effectiveness of Plaque Echolucency on Ultrasound as a Stroke Risk Stratification Tool in Asymptomatic Carotid Artery Stenosis

Abstract

Imaging may play an important role in identifying high-risk plaques in patient with carotid disease who could benefit from surgical revascularization. We sought to evaluate the cost-effectiveness of a decision-making rule based on the ultrasound (US) imaging assessment of plaque echolucency (PE) in patients with asymptomatic carotid stenosis. We developed a decision-analytic model to project lifetime quality-adjusted life years (QALYs) and costs for five stroke prevention strategies: 1) medical therapy only; 2) revascularization if both PE and stenosis progression to >90% is present; 3) revascularization only if PE is present; 4) revascularization only if stenosis progression >90% is present; or 5) either PE or stenosis progression is present. Risks of clinical events, costs, and quality-of-life values were estimated based on published sources and the analysis was conducted from a health care system perspective for asymptomatic patients with 70-89% carotid stenosis at presentation. Patients who did not undergo revascularization had the highest stroke events (16.9%) and lowest life-years, while those who underwent revascularization on the basis of either presence of PE on US or progression of carotid stenosis had the lowest stroke events (10.0%) and longest life-years (13.67). The either PE or progression-based revascularization group had an incremental cost effectiveness ratio of $43,000/QALY compared with those with revascularization based on having both PE and stenosis progression. Plaque echolucency on US can be a cost-effective tool to identify patients with asymptomatic carotid artery stenosis most likely to benefit from carotid endarterectomy.