Cost management strategies for carotid endarterectomy.
BACKGROUND
We developed a model for capitation and global pricing for carotid endarterectomy.


METHODS
A care algorithm for diagnosis, perioperative management, and postoperative care using cost data was developed. Perioperative care charges were extrapolated from a 1-year experience and applied to models to determine pricing for a 1-year global fee and a 5-year capitated contract.


RESULTS
Global pricing was estimated at $12,071 per patient while a capitated price for 5-year care was $17,175. Based on the age mix of the population, a per member, per month cost could be calculated assuming a frequency of 414 procedures per 100,000 patients over age 65 and 31 procedures per 100,000 patients under 65. Sources of costs were extensive preoperative diagnostic testing, particularly angiography, brain imaging, and cardiac evaluation.


CONCLUSIONS
Global pricing and capitation are both feasible for carotid endarterectomy. Each approach has unique risks and benefits.
Ricotta
J J
JJ
Department of Surgery, State University of New York at Stony Brook, 11794-8191, USA.
Hargadon
T
T
O'Brien-Irr
M
M
D000367:Age Factors; D000368:Aged; D000465:Algorithms; D000758:Anesthesia / Q000191:economics; D000792:Angiography / Q000191:economics; D002204:Capitation Fee; D016893:Carotid Stenosis / Q000175:diagnosis; D003365:Costs and Cost Analysis; D004358:Drug Therapy / Q000191:economics; D016894:Endarterectomy, Carotid / Q000191:economics*; D005251:Fees, Medical; D005500:Follow-Up Studies; D006760:Hospitalization / Q000191:economics; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000191:economics; D008875:Middle Aged; D009873:Operating Rooms / Q000191:economics; D012086:Reoperation; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex / Q000191:economics