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Complication-Specific In-Hospital Costs After Carotid Endarterectomy vs Carotid Artery Stenting

Hanaa Dakour-Aridi1, Besma Nejim1, Satinderjit Locham1

  • 11 The Johns Hopkins Bayview Vascular and Endovascular Research Center, Baltimore, MD, USA.

Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists
|June 13, 2018
PubMed

Insights

Carotid endarterectomy (CEA) is more cost-effective than carotid artery stenting (CAS) despite higher stroke costs. CEA offers lower complication rates and baseline costs, making it a preferred intervention for stroke prevention.

Area of Science:

  • Vascular Surgery
  • Health Economics
  • Clinical Outcomes Research

Background:

  • Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are procedures to prevent stroke.
  • Comparing the economic impact and patient outcomes of CEA versus CAS is crucial for clinical decision-making.

Purpose of the Study:

  • To quantify and compare the incremental costs of in-hospital stroke, death, and myocardial infarction (MI) following CEA versus CAS.
  • To evaluate the cost-effectiveness of these two carotid revascularization strategies.

Main Methods:

  • Retrospective analysis of 100,185 patients undergoing CEA or CAS between 2009-2015 from the Premier Healthcare Database.
  • Multivariate logistic and generalized linear models were used to analyze outcomes and hospitalization costs.
  • Outcomes were reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Main Results:

  • CAS showed significantly higher adjusted odds of stroke (aOR 1.55) and death (aOR 2.60) compared to CEA.
  • No significant difference in MI risk was observed between CEA and CAS.
  • The adjusted incremental cost of stroke was higher with CEA ($2000), particularly in asymptomatic patients.

Conclusions:

  • While CEA incurs higher incremental stroke costs, it remains more cost-effective due to lower overall complication rates and baseline expenses.
  • Further long-term cost-effectiveness studies are recommended to solidify conclusions on CEA versus CAS.
Abstract

Keywords:
carotid artery stentingcarotid endarterectomycomplicationscost analysishospital costsmortalitymyocardial infarctionstroke

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