Economic impact of endarterectomy vs carotid artery stenting: a one year, single centre study
Francesco Setacci1, Gianmarco de Donato, Emiliano Chisci
1Department of Surgery, Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy.
Insights
Costs for carotid artery stenting (CAS) and carotid endarterectomy (CEA) are comparable. Patient factors, not economics, should guide the choice between these carotid stenosis treatments.
Area of Science:
- Vascular Surgery
- Health Economics
- Interventional Cardiology
Background:
- Carotid artery stenting (CAS) is proposed as an alternative to carotid endarterectomy (CEA), particularly for specific patient groups.
- Evaluating the economic implications of CAS versus CEA is crucial for clinical decision-making.
Purpose of the Study:
- To compare the costs associated with carotid artery stenting (CAS) and carotid endarterectomy (CEA).
Main Methods:
- A retrospective cost analysis of elective carotid stenosis treatments performed between January and December 2006.
- Data included 184 CAS and 97 CEA cases, with prospectively gathered clinical and retrospectively obtained financial data.
- Adverse events were recorded: one major event and one transient ischemic attack (TIA) in CEA and CAS groups, respectively, with one procedure-related death in the CEA group.
Main Results:
- The mean total cost for CEA was €3,897.86, while for CAS it was €3,806.66.
- Higher material costs for CAS were offset by reduced hospital stay expenditures.
- Clinical outcomes showed comparable complication rates between the two procedures.
Conclusions:
- The overall costs for CAS and CEA are similar.
- Clinical decisions between CAS and CEA should prioritize patient comorbidity, lesion characteristics, and patient preference over economic factors.
Aims:
Carotid artery stenting (CAS) has been suggested by some clinicians as an alternative to endarterectomy (CEA), especially in some specific subgroups of the population. The aim of this study is to evaluate the costs of these two procedures.
Methods And Results:
A review of costs was performed on all patients who underwent elective treatment of carotid artery stenosis between January and December 2006 (184 CAS vs 97 CEA). Clinical data had been prospectively gathered from both the CAS and the CEA groups, while financial data was obtained retrospectively to match hospital admissions with the generated charge from the hospital business office. In this series there was one major event in CEA and one transient ischaemic attacks (TIA) in CAS. One death procedure-related event occurred in CEA. The mean total cost associated with a single CEA was slashed integral 3,897.86, whereas the cost associated with CAS was slashed integral 3,806.66. It was apparent that the increasing costs involved in purchasing material for CAS, were balanced by the lower spending for hospital stay.
Conclusions:
Costs for CAS and CEA are comparable. In our experience, the choice between CAS and CEA is based on the comorbidity of the patient, the type of the lesion and the preferences of the patient, without economic criteria being important.