title: Economic evaluation of carotid artery stenting versus carotid endarterectomy for the treatment of carotid artery stenosis.
abstract: BACKGROUND
  The clinical effectiveness of carotid endarterectomy (CEA) is well established. But the economic impact of CEA and carotid artery stenting (CAS) is still uncertain. The objective of this study was to compare hospital costs and reimbursement for CAS and CEA.
  
  
  METHODS
  We performed a retrospective database analysis on pair-matched patients who underwent CEA (n = 31) and CAS (n = 31) at the Richard M Ross Heart Hospital in Columbus, OH. The hospital's clinical and financial databases were used to obtain patient-specific information and procedural charges. Cost data were generated by applying the hospital's ratio of cost to charges for all DRG charges. The Wilcoxon signed-rank test was used to examine the differences between costs of these procedures.
  
  
  RESULTS
  Data are reported as mean +/- SD. The mean age of patients in CAS group was 70.14 years (+/- 1.60 years) versus 68.64 years (+/- 1.75 years) for CEA patients (p < 0.05). The total direct cost associated with CEA ($3,765.12+/-$2,170.82) was significantly lower than the CAS cost ($8,219.71+/-$2,958.55, p < 0.001). The mean procedural cost for CAS ($7,543.61+/-$2,886.54) was significantly higher than that for CEA ($2,720.00+/-$926.38, p < 0.001). The hospital experienced cost savings of $9,690.87 for CEA versus $4,804.79 for CAS from private insurance. Similarly, savings obtained by Medicare-enrolled CEA patients were higher than those for CAS patients ($1,497.79).
  
  
  CONCLUSIONS
  CAS is significantly more expensive than CEA, with a major portion of cost attributed to the total procedural cost. The hospital experienced significant savings from CEA procedures compared with CAS under all DRG classifications and insurers. Hospitals must develop new financial strategies and improve the efficiency of infrastructure to make CAS financially viable.
authors.affiliation: Department of Pharmacy Practice and Administration, Ohio State University College of Pharmacy, Columbus, OH 43210-1252, USA.
authors.forename: Manjiri
authors.initials: M
authors.lastname: Pawaskar
authors.forename: Bhagwan
authors.initials: B
authors.lastname: Satiani
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
authors.forename: Jean E
authors.initials: JE
authors.lastname: Starr
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000191:economics / Q000601:surgery*; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D016894:Endarterectomy, Carotid / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D018803:Models, Economic; D009820:Ohio; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015607:Stents / Q000191:economics*; D016896:Treatment Outcome