[Economic evaluation of carotid artery stenting compared with carotid endarterectomy in patients with carotid artery stenosis]

Park HS, Shin SJ, Hwang JS, Oh SH, Park JJ, Wu JH, Lee JY, Choi JE, Lee YE, Kim BM, Kim TS, Jeon P, Jo YP
Record ID 32015001109
Korean
Authors' recomendations: This study evaluated the clinical effectiveness and cost-effectiveness in the target patients with symptomatic carotid artery stenosis (more than 50% stenosis) who can undergo Carotid-artery stenting (CAS) as an alternative to carotid endarterectomy (CEA) for carotid artery stenosis. In this study, peri-procedure and post-procedure outcome of CAS was compared with those of CEA in patient with carotid artery stenosis in Korea. Between January 2008 and December 2011, 677 patients (CEA patients=331, CAS patients=346) with symptomatic carotid artery stenosis (≥50%) who underwent carotid intervention were enrolled. The average age of the total patients was 68.3 (range: 24-92 years), and there were 570 males (84.2%) and 107 female (15.8%). There was no difference in age and gender between two groups. Among peri-procedure outcomes, 30-day stroke rate was inferior in CAS group to CEA group, and it was statistically significant (4.99% vs. 1.89%, p=0.026, chi-test). There was no significant difference between CAS and CEA for death and MI within 30 days after treatment. As a result of the analysis in the whole period (up to 2 years) after treatment, the incidence rates of adverse events were not significantly different. Peri-operative complications (infection or hemorrhage) were less common with CAS than CEA. Rates of cranial nerve palsy were significantly reduced among patients treated CAS compared with CEA groups (p-value< 0.001, chi-test). The cost-utility analysis of CAS versus CEA was conducted for the patients with symptomatic carotid artery stenosis (≥50% stenosis) from Korean healthcare system perspectives. We used the Markov model to compare the expected costs and quality-adjusted life years (QALYs) during the 15 years of time horizon period. The health status was comprised of five states such as no major adverse events (NMAEs), myocardial infarction, major stroke, minor stroke, and death. The cycle length was 1 year. The incremental cost per the additional QALY gained of CAS compared to CEA was calculated. All future costs, and QALYs were discounted at 5% per year. Transition probability and clinical outcomes were estimated based on the retrospective medical chart review. We applied the utility index of Markov health states from the survey using TTO or EQ-5D. The costs were categorized into procedural costs and post-procedural costs related to complication. For symptomatic patients with carotid artery stenosis over 50%, the cost-utility analysis demonstrated that over a 15-year time horizon CEA was associated with a 0.22 QALY gained (6.49 QALYs for CAS versus 6.71 QALYs for CEA) and net cost savings of about KRW 1,690,000 (KRW 7,980,000 for CAS versus KRW 7,980,000 for CEA).
Details
Project Status: Completed
Year Published: 2014
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: South Korea
MeSH Terms
  • Humans
  • Cost-Benefit Analysis
  • Carotid Arteries
  • Carotid Stenosis
  • Stents
  • Endarterectomy, Carotid
Contact
Organisation Name: National Evidence-based healthcare Collaborating Agency
Contact Address: National Evidence-based Healthcare Collaborating Agency (NECA), 3~5F Health and Welfare Social Administration B/D, 400 Neungdong-ro, Gwangjin-gu, Seoul, Korea.
Contact Name: int@neca.re.kr
Contact Email: int@neca.re.kr
Copyright: National Evidence-based Healthcare Collaborating Agency (NECA)
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