A cost-effectiveness analysis of carotid artery stenting compared with endarterectomy

J Stroke Cerebrovasc Dis. Sep-Oct 2010;19(5):404-9. doi: 10.1016/j.jstrokecerebrovasdis.2009.08.003.

Abstract

Endarterectomy and angioplasty with stenting have emerged as 2 alternative treatments for carotid artery stenosis. This study's objective was to determine the cost-effectiveness of carotid artery stenting (CAS) compared with carotid endarterectomy (CEA) in symptomatic subjects who are suitable for either intervention. A Markov analysis of these 2 revascularization procedures was conducted using direct Medicare costs (2007 US$) and characteristics of a symptomatic 70-year-old cohort over a lifetime. In the base case analysis, CAS produced 8.97 quality-adjusted life-years, compared with 9.64 quality-adjusted life-years for CEA. The incremental cost of stenting was $17,700, and thus CAS was dominated by CEA. Sensitivity analyses show that the long-term probabilities of major stroke or mortality influenced the results. In the base case analysis, CEA for patients with symptomatic stenosis has a greater benefit than CAS, with lower direct costs. With 59% probability, CEA will be the optimal intervention when all of the model assumptions are varied simultaneously.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angioplasty / economics*
  • Angioplasty / instrumentation
  • Angioplasty / methods
  • Carotid Stenosis / economics
  • Carotid Stenosis / therapy*
  • Cohort Studies
  • Cost-Benefit Analysis
  • Decision Trees
  • Endarterectomy, Carotid / economics*
  • Endarterectomy, Carotid / methods
  • Humans
  • Markov Chains
  • Models, Economic
  • Quality-Adjusted Life Years*
  • Stents / economics
  • Stroke / prevention & control*