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Cost-effectiveness of Carotid Surgery
Sandra Vicente Jiménez1, Pilar Carrasco2, Gil Rodriguez3
1Department of Angiology and Vascular and Endovascular Surgery, Hospitales Sanitas, Madrid, Spain.
Annals of Vascular Surgery
|December 1, 2018
Summary
Carotid endarterectomy (CEA) is most cost-effective for asymptomatic patients, while transcervical stenting (TCS) offers better value for symptomatic patients. Both stenting methods provide outcomes comparable to CEA.
Area of Science:
- Vascular Surgery
- Health Economics
- Interventional Cardiology
Background:
- Carotid artery stenosis poses a significant risk for stroke.
- Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are primary interventions.
- Evaluating the cost-effectiveness of different revascularization strategies is crucial for clinical decision-making.
Purpose of the Study:
- To determine the short- and long-term cost-effectiveness of carotid endarterectomy (CEA) versus transfemoral stenting (TFS) and transcervical stenting (TCS).
- To compare these interventions in both symptomatic and asymptomatic patients with carotid stenosis.
Main Methods:
- Prospective data collection on costs and complications for CEA, TFS, and TCS from 2003-2014.
- Calculation of Quality-Adjusted Life Years (QALYs) and incremental cost-effectiveness ratios (ICERs).
- Analysis based on treatment received, with a significance level of 5%.
Main Results:
- CEA had lower median procedural and overall costs (€5499, €5595).
- TCS yielded better QALYs (7.3) for symptomatic patients; CEA yielded better QALYs (9.6) for asymptomatic patients.
- Cost-effectiveness was superior with TCS for symptomatic patients (€803/QALY) and CEA for asymptomatic patients (€654/QALY).
Conclusions:
- Transfemoral stenting (TFS) and transcervical stenting (TCS) offer clinical outcomes equivalent to CEA.
- TCS is more cost-effective for symptomatic patients.
- CEA demonstrates superior cost-effectiveness for asymptomatic patients.
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