The Cost Per Stroke Prevented (CPSP) from Symptomatic Carotid Artery Stenosis in Ontario, Canada (S51.006)
Bibliographic record
Abstract
BACKGROUND: North American guidelines recommend carotid artery revascularization for symptomatic carotid disease within 2 weeks of the index event. Recent literature has indicated that wait times for carotid revascularization are unacceptably high in Ontario with median wait times of 30-79 days. The effectiveness of carotid artery revascularization is maximal if done within 2 weeks, and declines precipitously thereafter. We sought to examine the financial costs associated with increased wait-times for carotid artery revascularization. DESIGN/METHODS: Using the Schedule of Health Care Benefits for Ontario, and commercial vendor prices the cost of Carotid Artery Angioplasty and Stenting (CAS) was calculated at $8,357 (CAD). Assuming parity of CAS with open surgery for stroke prevention, we created a mathematical model to simulate the cost of 100 consecutive, virtual CAS procedures ($835,760). The cost per stroke prevented (CPSP) based on the number-needed-to-treat (NNT) to prevent 1 ipsilateral stroke in 5 years as it related to the timing of revascularization was calculated. RESULTS: The CPSP if all 100 virtual patients were treated within the recommended 2 week timeframe (NNT-3) was calculated as $25,326, which represents 33 prevented strokes. The CPSP if all patients were treated within the 2-4 week period (NNT-6) was $49,162 representing 17 prevented strokes. The CPSP if all patients were treated within 1-3 months (NNT-9) was $75,978 representing 11 prevented strokes. Treatment >3 months (NNT-11) yielded a CPSP of $92,862 representing 9 prevented strokes. CONCLUSIONS: The CPSP if done within the recommended time-frame for our virtual population would be $25,326. Recent data from Ontario demonstrates that between 8-36% of carotid artery revascularizations occur within the suggested timeframe. Most carotid artery revascularizations in Ontario have a CPSP of $75,978 (median time for revascularization is between 1-3 months). This represents a clear inefficiency in the system. Further research and government wide initiatives could be aimed at increasing the awareness of the CPSP in order to facilitate policy makers and other stakeholders to develop pathways to ensure prompt treatment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".