Cost-effectiveness analysis of protected carotid artery stent placement versus endarterectomy in high-risk patients
Alberto Maud1, Gabriela Vázquez, John A Nyman
1Zeenat Qureshi Stroke Research Center, Department of Neurology, and , University of Minnesota, Minneapolis, MN 55455 USA. maudx006@umn.edu
Insights
Carotid angioplasty with stenting (CAS) is not more cost-effective than carotid endarterectomy (CEA) for high-risk patients with severe carotid stenosis. While CAS offers a marginal benefit, its higher cost offsets this advantage.
Area of Science:
- Vascular Surgery
- Health Economics
- Interventional Cardiology
Background:
- Severe carotid stenosis poses a significant stroke risk.
- Carotid endarterectomy (CEA) is a standard surgical treatment.
- Carotid angioplasty with stenting (CAS) is an alternative, particularly for high-risk patients.
Purpose of the Study:
- To compare the cost-effectiveness of CAS with emboli protection versus CEA.
- To evaluate these interventions in patients with severe carotid stenosis at high surgical risk.
Main Methods:
- Utilized outcomes data from the SAPPHIRE trial.
- Estimated quality-adjusted life years (QALYs) based on stroke, myocardial infarction, and death.
- Calculated total costs and incremental cost-effectiveness ratios (ICERs) in 2006 US dollars for a 1-year period.
Main Results:
- CAS cost $12,782 vs. CEA's $8,916 at 1 year.
- CAS yielded 0.753 QALYs vs. CEA's 0.701 QALYs.
- Mean cost per QALY gained was $16,223 for CAS and $12,745 for CEA.
Conclusions:
- CAS is not superior to CEA in terms of cost-effectiveness for high-risk patients.
- The marginal benefit of CAS is outweighed by its higher procedural costs.
- CEA remains a more cost-effective option for this patient group.
Purpose:
To determine the cost-effectiveness of carotid angioplasty with stent placement (CAS) under emboli protection versus carotid endarterectomy (CEA) in patients with severe carotid stenosis considered to be at high surgical risk for CEA.
Methods:
The probabilities of various outcomes were adopted from the SAPPHIRE trial results. The quality-adjusted life year (QALYs) associated with each treatment modality were estimated by using the frequencies of various quality-adjusted outcomes (QALY weights of ipsilateral stroke, myocardial infarction, and death). Total cost associated with each intervention was computed using the frequency of stroke, myocardial infarction, and death in each group. Costs are expressed in 2006 US$. Incremental cost-effectiveness ratios (ICERs) were estimated for a 1-year postprocedure period.
Results:
The mean (range) estimated net costs at 1 year for patients treated with CAS and CEA were $12,782 ($12,205-$13,563) and $8,916 ($8,267-$9,766), respectively. Overall QALYs for the CAS and CEA groups were 0.753 and 0.701 [within a range of 0.0 (meaning death) to 0.815 (meaning no adverse events)]. The mean cost per QALY gained for CAS was $16,223 ($15,315-$17,474) and the mean cost per QALY gained for CEA was $12,745 ($11,372-$14,605). The estimated median ICER for CAS versus CEA treatment was $67,891 (-$129,372 to $379,661).
Conclusion:
The proven non-inferiority of CAS versus CEA in high-surgical-risk patients with severe carotid stenosis might provide a marginal benefit that is offset by the higher cost associated with this procedure.
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