Development of a Microsimulation Model to Predict Stroke and Long-Term Mortality in Adherent and Nonadherent Medically Managed and Surgically Treated Octogenarians with Asymptomatic Significant Carotid Artery Stenosis.

Abstract

BACKGROUND:

The primary study objective was to develop a microsimulation model to predict preventable first-ever and recurrent strokes and mortality for a population of medically or surgically managed octogenarians with substantial (>60%) asymptomatic carotid artery stenosis and comparing an adherent with a real-world nonadherent best medical treatment (BMT) regimen subjected to sex.

METHODS:

A Monte Carlo microsimulation model was constructed with a 14-year time horizon and with 10,000 patients. Probabilities and values for clinical outcomes were obtained from the current literature.

RESULTS:

The stratification of the microsimulation estimates by treatment strategy within the female group of octogenarians showed a statistically significant lower stroke rate during follow-up for carotid endarterectomy (CEA) compared with nonadherent BMT (P < 0.0001) as well as compared with adherent BMT (P < 0.0001). In male octogenarians, the CEA strategy was also associated with statistically significant lower stroke rates compared with adherent and nonadherent BMT (P < 0.0001 and P < 0.0001, respectively). For each treatment strategy, female octogenarians had a statistically significant longer overall long-term survival compared with male octogenarians (P < 0.0001, respectively). In terms of stratification by sex, in octogenarian men and women, long-term survival was significantly better for adherent BMT compared with nonadherent BMT, and CEA was associated with a significant better long-term survival compared with nonadherent BMT.

CONCLUSIONS:

In the present microsimulation, in real-world drug adherence, it was likely that a strategy of early endarterectomy was beneficial in octogenarians with significant asymptomatic carotid artery disease compared with BMT alone.

• Authors: Thomas Luebke, Jan Brunkwall
• Journal: World neurosurgery (World Neurosurg) Vol. 92 Pg. 513-520.e2 (Aug 2016) ISSN: 1878-8769 [Electronic] United States
• PMID: 27237419 (Publication Type: Journal Article)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Chemical References

• Fibrinolytic Agents

Topics

• Aged
• Aged, 80 and over
• Asymptomatic Diseases (mortality)
• Carotid Stenosis (mortality, therapy)
• Combined Modality Therapy (mortality, statistics & numerical data)
• Computer Simulation
• Endarterectomy, Carotid (mortality)
• Female
• Fibrinolytic Agents (therapeutic use)
• Geriatric Assessment (statistics & numerical data)
• Humans
• Longitudinal Studies
• Male
• Medication Adherence (statistics & numerical data)
• Postoperative Complications (mortality, prevention & control)
• Prognosis
• Proportional Hazards Models
• Reproducibility of Results
• Risk Assessment (methods)
• Stroke (mortality)