Cost-Effectiveness of Carotid Artery Stenting Compared to Carotid Endarterectomy in Patients with Carotid Stenosis: A Turkish Health System Perspective

Year 2025, Volume: 15 Issue: 1, 15 - 21, 28.03.2025

İzzet Aydemir , Afsun Ezel Esatoğlu

https://doi.org/10.33808/clinexphealthsci.1315072

Abstract

Objective: This study assesses the cost-effectiveness of carotid artery stenting (CAS) versus carotid endarterectomy (CAE) from the perspective of payers in Türkiye, considering potential complications.
Methods: A decision tree analysis model was employed using data from 61 patients (29 CAS, 32 CAE) treated for carotid stenosis (CS) between 2019-2021. The procedural costs were derived from a university hospital-billing department, while health outcomes such as any stroke and myocardial infarction (MI) and their utility values were based on meta-analyses and established studies. The primary outcome measure was the incremental cost-effectiveness ratio (ICER).
Results: When the model was applied, CAS incurred higher costs ( USD per patient) compared to CAE (USD 947,30), resulting in an ICER of USD 96.345 per QALY. CAE, as a traditional model, demonstrated dominance due to its lower costs and slightly better outcomes. Sensitivity analysis showed that a ±10% change in input parameters, particularly a higher impact was observed in costs and stroke incidence and could alter the ICER about ± USD 1.225 to 3.500. Budget impact analysis estimated CAS and CAE affecting 4.37% and 3.09% of the healthcare budget, respectively.
Conclusion: CAE demonstrated superior cost-effectiveness over CAS in treating CS within the Turkish healthcare system. Despite CAS's appeal as a less invasive option, its higher costs and marginal effectiveness suggest that CAE should be prioritized unless parameters such as procedural costs and any stroke risks associated with CAS are reduced.

Keywords

Carotid Stenosis, Carotid Artery Stenting, Carotid Endarterectomy, Cost-Effectiveness, ICER

Ethical Statement

This study was approved by Ethics Committee of Ankara University, (approval date 2021 and number 14.)

Supporting Institution

none

Project Number

none

Thanks

none

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