Screening and Treatment of Carotid Stenosis in Patients with HPV-Associated Oropharyngeal Cancer
- 1Baylor College of Medicine
Abstract
Patients with history of neck radiation for Human Papilloma Virus (HPV)-associated head and neck cancer experience rapid progression of carotid artery stenosis. The present study sought to determine whether screening and treating asymptomatic carotid artery stenosis in patients with a history of neck radiation is cost-effective. This study is a cost-utility analysis using a probabilistic Markov model over a thirty-year time horizon assessing carotid screening and treatment to avoid neurologic consequences of neck radiation for HPV-associated head and neck cancer. A strategy of no carotid surveillance was associated with a 14.8% cumulative risk of stroke and a strategy of ultrasound surveillance and treatment with TCAR was associated with a 3.0% cumulative risk of stroke. The latter had a median incremental cost of $1.04 million USD and provided a median 39.1 additional QALYs, resulting in a median incremental cost-effectiveness ratio of $26,556 per QALY. In conclusion, this study suggests that ultrasound surveillance and treatment with TCAR for asymptomatic carotid artery stenosis is likely to be cost-effective for patients who have been successfully treated with radiation therapy for HPV-associated head and neck cancer.
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BibTeX
@misc{greenleaf2026screening,
title = {{Screening and Treatment of Carotid Stenosis in Patients with HPV-Associated Oropharyngeal Cancer}},
author = {E. K. Greenleaf and V. Sandulache and S. P. R. Manikonda and N. R. Barshes},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.01.26361951},
url = {https://www.medrxiv.org/content/10.64898/2026.09.01.26361951v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Screening and Treatment of Carotid Stenosis in Patients with HPV-Associated Oropharyngeal Cancer
AU - E. K. Greenleaf
AU - V. Sandulache
AU - S. P. R. Manikonda
AU - N. R. Barshes
PY - 2026
DA - 2026/09/01
PB - medRxiv
DO - 10.64898/2026.09.01.26361951
UR - https://www.medrxiv.org/content/10.64898/2026.09.01.26361951v1
AB - Patients with history of neck radiation for Human Papilloma Virus (HPV)-associated head and neck cancer experience rapid progression of carotid artery stenosis. The present study sought to determine whether screening and treating asymptomatic carotid artery stenosis in patients with a history of neck radiation is cost-effective. This study is a cost-utility analysis using a probabilistic Markov model over a thirty-year time horizon assessing carotid screening and treatment to avoid neurologic consequences of neck radiation for HPV-associated head and neck cancer. A strategy of no carotid surveillance was associated with a 14.8% cumulative risk of stroke and a strategy of ultrasound surveillance and treatment with TCAR was associated with a 3.0% cumulative risk of stroke. The latter had a median incremental cost of $1.04 million USD and provided a median 39.1 additional QALYs, resulting in a median incremental cost-effectiveness ratio of $26,556 per QALY. In conclusion, this study suggests that ultrasound surveillance and treatment with TCAR for asymptomatic carotid artery stenosis is likely to be cost-effective for patients who have been successfully treated with radiation therapy for HPV-associated head and neck cancer.
ER -