title: A cost-effectiveness analysis of carotid artery stenting compared with endarterectomy.
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.
authors.affiliation: Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA. kate_young@urmc.rochester.edu
authors.forename: Kate C
authors.initials: KC
authors.lastname: Young
authors.forename: Robert G
authors.initials: RG
authors.lastname: Holloway
authors.forename: W Scott
authors.initials: WS
authors.lastname: Burgin
authors.forename: Curtis G
authors.initials: CG
authors.lastname: Benesch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D016893:Carotid Stenosis / Q000191:economics / Q000628:therapy*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D016894:Endarterectomy, Carotid / Q000191:economics* / Q000379:methods; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D015607:Stents / Q000191:economics; D020521:Stroke / Q000517:prevention & control*
references.citation: Circulation. 1996 Nov 1;94(9 Suppl):II194-8
references.pmid: 8901745
references.citation: Catheter Cardiovasc Interv. 2007 Feb 15;69(3):341-8
references.pmid: 17171654
references.citation: Stroke. 1988 Dec;19(12):1497-500
references.pmid: 3201508
references.citation: N Engl J Med. 2006 Oct 19;355(16):1660-71
references.pmid: 17050890
references.citation: Lancet Neurol. 2008 Oct;7(10):893-902
references.pmid: 18774746
references.citation: Neuroepidemiology. 2001 Feb;20(1):26-30
references.pmid: 11174042
references.citation: J Am Coll Cardiol. 2006 Jun 20;47(12):2384-9
references.pmid: 16781363
references.citation: J Vasc Surg. 2003 Mar;37(3):575-81
references.pmid: 12618695
references.citation: Semin Vasc Surg. 2007 Dec;20(4):259-66
references.pmid: 18082843
references.citation: Neurology. 2004 Feb 24;62(4):569-73
references.pmid: 14981172
references.citation: J Vasc Surg. 1999 Dec;30(6):1024-33
references.pmid: 10587386
references.citation: Eur J Vasc Endovasc Surg. 2007 Oct;34(4):470-9
references.pmid: 17683960
references.citation: Stroke. 2001 Jun;32(6):1425-9
references.pmid: 11387509
references.citation: N Engl J Med. 2004 Oct 7;351(15):1493-501
references.pmid: 15470212
references.citation: Lancet. 2006 Oct 7;368(9543):1239-47
references.pmid: 17027729
references.citation: N Engl J Med. 2008 Apr 10;358(15):1572-9
references.pmid: 18403765
references.citation: J Vasc Surg. 2007 Mar;45(3):523-6
references.pmid: 17257803
references.citation: Stroke. 1998 Dec;29(12):2491-500
references.pmid: 9836757
references.citation: J Vasc Surg. 1997 Feb;25(2):298-309; discussion 310-1
references.pmid: 9052564
references.citation: J Vasc Surg. 2003 Feb;37(2):331-9
references.pmid: 12563203
references.citation: J Neurosurg. 2007 Feb;106(2):217-21
references.pmid: 17410702
references.citation: Eur Heart J. 2008 Jan;29(1):113-9
references.pmid: 17881346
references.citation: J Vasc Surg. 2006 Aug;44(2):258-68
references.pmid: 16890850
references.citation: Lancet Neurol. 2008 Oct;7(10):885-92
references.pmid: 18774745
references.citation: Neurology. 1998 Jan;50(1):208-16
references.pmid: 9443482
references.citation: Catheter Cardiovasc Interv. 2006 Apr;67(4):503-12
references.pmid: 16548004