Document Detail


Costs and cost-effectiveness of carotid stenting vs. endarterectomy for patients at increased surgical risk: Results from the SAPPHIRE trial.
MedLine Citation:
PMID:  21061242     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES.: To evaluate the cost-effectiveness of carotid stenting vs. carotid endarterectomy using data from the SAPPHIRE trial. BACKGROUND.: Carotid stenting with embolic protection has been introduced as an alternative to carotid endarterectomy for prevention of cerebrovascular and cardiovascular events among patients at increased surgical risk. METHODS.: Between August 2000 and July 2002, 310 patients with an accepted indication for carotid endarterectomy but at high risk of complications were randomized to and subsequently underwent either carotid stenting (n=159) or endarterectomy (n=151). Clinical outcomes, resource use, costs, and quality of life were assessed prospectively for all patients over a 1-year period. Life expectancy, quality-adjusted life expectancy, and health care costs beyond the follow-up period were estimated for patients alive at 1 year, based on observed clinical events during the first year of follow-up. RESULTS.: Although initial procedural costs were significantly higher for stenting than for endarterectomy (mean difference: $4081/patient; 95% CI, $3849-$4355), mean post-procedure length of stay was shorter for stenting (1.9 vs. 2.9 days; p<0.001) with significant associated cost offsets. As a result, initial hospital costs were just $559/patient higher with stenting (95% CI, $3470 less to $2289 more). Neither follow-up costs after discharge nor total 1-year costs differed significantly. The incremental cost-effectiveness ratio for stenting compared with endarterectomy was $6555 per quality-adjusted life year (QALY) gained, with over 98 percent of bootstrap estimates <$50,000/QALY gained. CONCLUSIONS.: Although carotid stenting with embolic protection is more costly than carotid endarterectomy, by commonly accepted standards stenting is an economically attractive alternative to endarterectomy for patients at high surgical risk. © 2010 Wiley-Liss, Inc.
Authors:
Cohen David
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2010-11-8
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  -     ISSN:  1522-726X     ISO Abbreviation:  -     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
4401 Wornall Rd, Kansas City, Missouri, United States, 64111.
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