Document Detail


A cost-effectiveness analysis of carotid artery stenting compared with endarterectomy.
MedLine Citation:
PMID:  20816349     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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:
Kate C Young; Robert G Holloway; W Scott Burgin; Curtis G Benesch
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association     Volume:  19     ISSN:  1532-8511     ISO Abbreviation:  J Stroke Cerebrovasc Dis     Publication Date:    2010 Sep-Oct
Date Detail:
Created Date:  2010-09-06     Completed Date:  2011-01-13     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  9111633     Medline TA:  J Stroke Cerebrovasc Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  404-9     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA. kate_young@urmc.rochester.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angioplasty / economics*,  instrumentation,  methods
Carotid Stenosis / economics,  therapy*
Cohort Studies
Cost-Benefit Analysis
Decision Trees
Endarterectomy, Carotid / economics*,  methods
Humans
Markov Chains
Models, Economic
Quality-Adjusted Life Years*
Stents / economics
Stroke / prevention & control*
Grant Support
ID/Acronym/Agency:
1UL1RR024160-01/RR/NCRR NIH HHS; K24 NS042098-05/NS/NINDS NIH HHS; K24NS42098/NS/NINDS NIH HHS; R01 HL080107-01A1/HL/NHLBI NIH HHS; R01HL080107/HL/NHLBI NIH HHS; T32 HL007937/HL/NHLBI NIH HHS; T32 HL007937-01/HL/NHLBI NIH HHS; T32HL007937/HL/NHLBI NIH HHS; UL1 RR024160/RR/NCRR NIH HHS
Comments/Corrections

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