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

background

Carotid stenosis is a major  cause of stroke with carotid-related strokes often leading to disability or death.  Stroke risk can be reduced with effective  medical therapy.  Carotid artery stenting (CAS) or carotid endarterectomy (CEA) could further reduce the risk of stroke risk but have procedural risks.

ACST-2, the largest carotid surgery trial to date, randomised 3625 patients with neither a  recent stroke nor 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 also reported on the comparable efficacy of both procedures at 5 years, with a 10-year median follow-up  expected in 2025.

Carotid practice worldwide continuously evolves towards personalised disease management tailored to  individual patient risks and potential to benefit from treatment. Economic evidence on  the value of different treatment options for different patients  is limited. The ACST-2 study  randomised studies and observational data that could inform the net effects and cost-effectiveness of treatments for  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  health economists in  NDPH. 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 for networking both with the health economics and cardiovascular policy community. The results of this DPhil project  are likely to be impactful, and the student will be encouraged  to present the results  internally, nationally and internationally, and produce to produce  reports and papers for peer reviewed journals.

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 Masters degree in a relevant area (e.g. health economics or policy/ medical statistics/ epidemiology), and a strong interest to develop in the area of health economics and policy.