[Carotid stenosis in high risk patients. The SAPPHIRE study versus a decision analysis. Which is the best therapeutic option?].
BACKGROUND
In the results from the SAPPHIRE study on high surgical risk patients with carotid stenosis there are no differences between carotid stent-angioplasty (CSA) and carotid endarterectomy (CEA).


OBJECTIVE
The aim of this study was to analyse the cost-effectiveness of these two interventions based on the data from the above-mentioned study and on our own experience in carotid surgery.


METHODS
We evaluated 108 CSA carried out between 1999 and 2003. The morbidity and mortality rates in the subgroup of high risk patients, according to the criteria used in the SAPPHIRE study, were analysed according to whether they were symptomatic or asymptomatic. Data concerning endovascular treatment were taken from the literature. A cost-effectiveness study was conducted considering four possible perioperative events: absence of sequelae, AMI, established CVA and death. The computer software package DATAPro was used after fitting the decision to the theoretical quality of life for each of these groups. Cost-effectiveness was estimated based on the cost of each procedure.


RESULTS
Of the 108 patients, 41 (37.96%) belonged to the high risk subgroup; 46.3% of them were asymptomatic and 53.7% were symptomatic. In the 30 days following the intervention, one CVA (5.2%) and one AMI (4.5%) were observed. No deaths occurred. The decision analysis for symptomatic patients showed CEA to be the most effective therapeutic option. Similar results were obtained for asymptomatic patients. The average cost for CEA was 3,963 euros and rose to 5,158 euros in the case of CSA.


CONCLUSIONS
In our study, CEA is the preferred technique in high risk patients owing to its having a better cost-benefit ratio.
Arrébola-López
M
M
Servicio de Angiología y Cirugía Vascular, Hospital Universitario Joan XXIII, 43007 Tarragona, Spain. 31712eho@comb.es
Hernández-Osma
E
E
Gómez-Moya
B
B
Rodríguez-Espinosa
N
N
Pañella-Agustí
F
F
Admetller-Castiglione
X
X
García-Vidal
R
R
Martín-Paredero
V
V
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods / Q000706:statistics & numerical data*; D016893:Carotid Stenosis / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016894:Endarterectomy, Carotid / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome