Journal of Stroke and Cerebrovascular Diseases
Original ArticleA Cost-Effectiveness Analysis of Carotid Artery Stenting Compared With Endarterectomy
Section snippets
Methods
A Markov model was designed to compare the costs and utilities of CAS and CEA. The present analysis is based primarily on the results of a recent meta-analysis and other published trials.6, 7, 8, 9, 10, 11, 12, 13
Results
In the base case analysis, the lifetime costs of CEA were $35,200 and the quality-adjusted life-years (QALYs) were 9.64. CAS was associated with lifetime costs of $52,900 and a QALY gain of 8.97. CAS was dominated by CEA because it was associated with a smaller QALY gain at higher lifetime medical costs.
The assumptions in the model were tested through one-way deterministic sensitivity analyses. If the long-term stroke rate after CEA increased from 2.1% per year to 6.3% per year, then CAS became
Discussion
In the base case analysis, CEA was the dominant option for the treatment of symptomatic carotid stenosis in a hypothetical cohort suitable for either CEA or CAS. CEA maximizes health benefits and cost savings. Deterministic sensitivity analyses showed that the assumptions regarding long-term stroke rates and mortality influence the suitability of CEA as the most cost-effective option. With lower thresholds for cost-effectiveness, the probability that CEA is treatment of choice increased from
References (27)
- et al.
Is carotid endarterectomy cost-effective in symptomatic patients with moderate (50% to 69%) stenosis?
J Vasc Surg
(1999) - et al.
Is carotid angioplasty and stenting more cost- effective than carotid endarterectomy?
J Vasc Surg
(2003) - et al.
Meta-analysis of randomized trials comparing carotid endarterectomy and endovascular treatment
Eur J Vasc Endovasc Surg
(2007) - et al.
Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenosis at 2 years: A multinational, prospective, randomised trial
Lancet Neurol
(2008) - et al.
Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: Results up to 4 years from a randomised, multicentre trial
Lancet Neurol
(2008) - et al.
Protected carotid stenting in high-surgical-risk patients: The ARCHeR results
J Vasc Surg
(2006) - et al.
Is the rationale for carotid angioplasty and stenting in patients excluded from NASCET/ACAS or eligible for ARCHeR justified?
J Vasc Surg
(2003) - et al.
Protected carotid stenting in high-risk patients with severe carotid artery stenosis
J Am Coll Cardiol
(2006) - et al.
Carotid artery velocity characteristics after carotid artery angioplasty and stenting
J Vasc Surg
(2007) Recurrent carotid stenosis after CEA and CAS: Diagnosis and management
Semin Vasc Surg
(2007)
Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies
Neurology
Cost-effectiveness of carotid endarterectomy in asymptomatic patients
J Vasc Surg
Is carotid endarterectomy cost-effective? An analysis of symptomatic and asymptomatic patients
Circulation
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K.C.Y. was supported in part by National Institutes of Health (NIH) Grant T32HL007937 (to Dr. Thomas A. Pearson, Department of Community and Preventive Medicine, University of Rochester). R.G.H. was supported in part by National Institute of Neurological Disorders Grant K24NS42098. C.G.B. is supported in part by NIH Grant RO1HL080107. This publication was made possible in part by Grant 1UL1RR024160-01 from the National Center for Research Resources (NCRR), a component of the NIH, and the NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Information on NCRR is available at http://www.ncrr.nih.gov/. Information on Reengineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp. A portion of the salary of K.C.Y., R.G.H., and C.G.B. is covered by NIH funds. W.S.B. and C.G.B. received clinical research grant support for ACT-1 (Abbott) and CREST (NIH).
The authors had full access to the data and take responsibility for its integrity. All of the authors have read and agreed to the manuscript as written.