Controversies in Management: Purchasers need a broader perspective

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Abstract
Two comparable multicentre randomised controlled trials have measured the outcome of carotid endartarectomy in people with severe symptomatic carotid artery stenosis. The reduction in the absolute risk of a disabling or fatal stroke (the outcome with probably the greatest public health significance) was estimated at 5% in the European trial2 and 10% in the North American study.3 Both studies used experienced surgeons with a good operative record. These figures provide compelling evidence of the benefit to individuals from surgery, which should not be ignored. Of course, people in this risk group often die of other causes, but the absolute benefit of endarterectomy remains, even when such deaths are taken into account.