Added value of carotid endarterectomy (CEA) and carotid artery stenting (CAS) to prevent stroke in asymptomatic patients

background

Carotid stenosis is an important cause of stroke with carotid-related strokes being frequently disabling or fatal. Stroke risk can be reduced with good medical therapy.  Carotid artery stenting (CAS) or carotid endarterectomy (CEA) could further reduce stroke risk but have procedural risks.

ACST-2, the largest-ever carotid surgery trial, randomised 3625 patients with no recent stroke or stroke-like symptoms to CEA or CAS and reported effects on procedural hazards (stroke, heart attack or any death at 30 days) and long-term stroke rates. The study reported comparable efficacy of both procedures at five years. 10-year median follow-up is expected in 2025.

Carotid practice worldwide continuously evolves towards personalised disease management in view of individual patient risks and potential to benefit. Economic evidence for value of different treatment options in categories of patients is lacking. The ACST-2 study, further randomised studies and observational data could inform net effects and cost-effectiveness of treatments in different patients. 

RESEARCH EXPERIENCE, RESEARCH METHODS AND TRAINING

The successful applicant will work with the ACST team (comprising academic vascular surgeons, trial administrators, medical statisticians) and senior health economists at Oxford Population Health. They will gain experience in health economics, working with individual participant data from clinical trials and population cohorts, evidence synthesis and decision analytic modelling. Training will encompass targeted courses, opportunities of networking both with health economics and cardiovascular policy community. The results of this work are likely to be impactful, and the student will be expected to present the results internally, nationally and internationally, and produce several reports.

FIELD WORK, SECONDMENTS, INDUSTRY PLACEMENTS AND TRAINING

Opportunities exist for collaborative work with other carotid trialists working in Europe and North America via the Carotid Stenosis Trialists’ Collaboration (CSTC).

PROSPECTIVE  STUDENT

The ideal candidate will have a master's degree in a relevant area (eg health economics or policy/ medical statistics/ epidemiology), and a strong interest to develop in the area of health economics and policy.