[Carotid stenosis in high risk patients. The SAPPHIRE study versus a decision analysis. Which is the best therapeutic
M Arrébola-López1, E Hernández-Osma, B Gómez-Moya
1Servicio de Angiología y Cirugía Vascular, Hospital Universitario Joan XXIII, 43007 Tarragona, Spain. 31712eho@comb.es
Insights
Carotid endarterectomy (CEA) is more cost-effective than carotid stent-angioplasty (CSA) for high-risk patients with carotid stenosis. This analysis, based on SAPPHIRE study data and local experience, favors CEA for better cost-benefit in these patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Health Economics
Background:
- The SAPPHIRE study found no significant difference between carotid stent-angioplasty (CSA) and carotid endarterectomy (CEA) in high-risk patients with carotid stenosis.
- This study aimed to evaluate the cost-effectiveness of these interventions.
Purpose of the Study:
- To conduct a cost-effectiveness analysis of carotid stent-angioplasty (CSA) versus carotid endarterectomy (CEA) in high-risk patients with carotid stenosis.
- To compare the two procedures using data from the SAPPHIRE study and local surgical experience.
Main Methods:
- A cost-effectiveness analysis was performed on 108 CSA procedures and literature data for endovascular treatment.
- Morbidity and mortality rates were analyzed in high-risk patients (symptomatic and asymptomatic).
- Decision analysis considered perioperative events (sequelae, AMI, CVA, death) and quality of life.
Main Results:
- In the high-risk subgroup (41 patients), 46.3% were asymptomatic and 53.7% were symptomatic.
- Perioperative complications included one CVA (5.2%) and one AMI (4.5%) within 30 days; no deaths occurred.
- Carotid endarterectomy (CEA) was found to be the most effective option for both symptomatic and asymptomatic patients, with an average cost of 3,963 euros compared to 5,158 euros for CSA.
Conclusions:
- Carotid endarterectomy (CEA) is the preferred intervention for high-risk patients with carotid stenosis.
- CEA demonstrates a superior cost-benefit ratio compared to carotid stent-angioplasty (CSA) in this patient population.
Introduction:
In the results from the SAPPHIRE study on high surgical risk patients with carotid stenosis there are no differences between carotid stent-angioplasty (CSA) and carotid endarterectomy (CEA).
Aims:
The aim of this study was to analyse the cost-effectiveness of these two interventions based on the data from the above-mentioned study and on our own experience in carotid surgery.
Patients And Methods:
We evaluated 108 CSA carried out between 1999 and 2003. The morbidity and mortality rates in the subgroup of high risk patients, according to the criteria used in the SAPPHIRE study, were analysed according to whether they were symptomatic or asymptomatic. Data concerning endovascular treatment were taken from the literature. A cost-effectiveness study was conducted considering four possible perioperative events: absence of sequelae, AMI, established CVA and death. The computer software package DATAPro was used after fitting the decision to the theoretical quality of life for each of these groups. Cost-effectiveness was estimated based on the cost of each procedure.
Results:
Of the 108 patients, 41 (37.96%) belonged to the high risk subgroup; 46.3% of them were asymptomatic and 53.7% were symptomatic. In the 30 days following the intervention, one CVA (5.2%) and one AMI (4.5%) were observed. No deaths occurred. The decision analysis for symptomatic patients showed CEA to be the most effective therapeutic option. Similar results were obtained for asymptomatic patients. The average cost for CEA was 3,963 euros and rose to 5,158 euros in the case of CSA.
Conclusions:
In our study, CEA is the preferred technique in high risk patients owing to its having a better cost-benefit ratio.
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