European Journal of Vascular & Endovascular Surgery
Volume 36, Issue 3 , Pages 258-264, September 2008

Carotid Stenting versus Carotid Endarterectomy: Evidence Basis and Cost Implications

  • M.P. Janssen

      Affiliations

    • Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
    • Corresponding Author InformationCorresponding author. M.P. Janssen, MSc, University Medical Center Utrecht, Medical Technology Assessment Department, STR 6.131, P.O.-box 85 500, 3508 GA Utrecht, The Netherlands. Tel.: +31 88 755 3246; fax: +31 88 755 5485.
    • ,
  • G.J. de Borst

      Affiliations

    • Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands
    • ,
  • W.P.Th.M. Mali

      Affiliations

    • Department of Radiology, University Medical Center Utrecht, The Netherlands
    • ,
  • L.J. Kappelle

      Affiliations

    • Department of Neurology, University Medical Center Utrecht, The Netherlands
    • ,
  • F.L. Moll

      Affiliations

    • Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands
    • ,
  • R.G.A. Ackerstaff

      Affiliations

    • Department of Clinical Neurophysiology, St. Antonius Hospital Nieuwegein, The Netherlands
    • ,
  • P.M. Rothwell

      Affiliations

    • Department of Clinical Neurology, University of Oxford, UK, on behalf of the European Carotid Surgery Trialists' Collaborative Group
    • ,
  • M.M. Brown

      Affiliations

    • Institute of Neurology, University College London, UK, on behalf of the CAVATAS investigators
    • ,
  • M.R. van Sambeek

      Affiliations

    • Department of Vascular Surgery, Catharina Hospital Eindhoven, The Netherlands, on behalf of the EuroCAST Steering Committee
    • ,
  • E. Buskens

      Affiliations

    • Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
    • MTA unit, Department of Clinical epidemiology, University Medical Center Groningen, University of Groningen, The Netherlands

Received 14 February 2008; accepted 17 May 2008. published online 24 July 2008.

Abstract 

Objective

Carotid Angioplasty combined with Stenting (CAS) is increasingly performed because of its presumed benefits. A study was performed to identify key factors that determine the cost-effectiveness as compared to conventional carotid endarterectomy (CEA).

Methods

The incremental cost-effectiveness of CAS over CEA for different scenarios was estimated using a modeling approach. Treatment costs were based on actual costs of successful procedures whereas costs of complications were taken from the literature. Patient survival was modeled using the endarterectomy patients from the ECST trial.

Results

Procedural costs of CAS are higher than those of CEA, mainly as a result of the high material costs. Cost-effectiveness of CAS primarily depends on major stroke rates. One percent increase in the peri-operative major stroke rate causes a cost increase of €1 051 and a loss of 0.06 quality adjusted life years.

Conclusions

At present CAS is at best non-inferior to CEA in terms of clinical outcome. Cost savings due to shorter admission are offset by the high costs associated with catheter-based interventions. At present CAS should be restricted to controlled settings until clinical trials have shown a substantial clinical benefit.

Keywords: Carotid arteries, Angioplasty, Stenting, Surgery, Cost-effectiveness

 

PII: S1078-5884(08)00290-6

doi:10.1016/j.ejvs.2008.05.008

European Journal of Vascular & Endovascular Surgery
Volume 36, Issue 3 , Pages 258-264, September 2008

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