ASSESSMENT OF COST-EFFECTIVENESS OF CAROTID ENDARTERECTOMY AND CAROTID ARTERY STENTING FROM PAYER PERSPECTIVE

Yıl 2023, Cilt: 26 Sayı: 1, 193 - 206, 22.03.2023

İzzet Aydemir , Afsun Ezel Esatoğlu , İhsan Doğan

Öz

The aim of this research is to evaluate the clinical and cost effectiveness of carotid artery stenting (CAS) and carotid endarterectomy (CAE) procedures in the treatment of carotid artery stenosis disease. In this retrospective and cross-sectional research, the cost data of 61 patients diagnosed with carotid artery stenosis disease and treated with CAS and CAE procedures at Ankara University İbni-Sina Hospital between 2019-2021 were analyzed and the EQ-5D-5L quality of life scale was applied to the patients by telephone. From the perspective of the reimbursement institution within the scope of fee for service payment, the average cost per patient being treated with CAS is 9.328.67₺, and the QALYs value is 0.7974 units; the average cost per patient being treated with CAE was 6,484.13₺, and the QALYs value was 0.7887 units. VAS scores were detected approximately 0,79 in the CAS procedure, and about 0,83 in CAE procedure. As a result of the analysis, the ICER value was calculated as 326,958.62₺ per QALYs gained. In the cost-effectiveness plane, ICER was located whereon the recommended cost-effectiveness threshold. Under the assumption of 1.5% annual prevalence of carotid artery stenosis disease, the effect of the CAS procedure on the budget was 4.51%, and the effect of the CAE procedure on the budget was about 3.14% respectively. As a result, it was observed that the CAS procedure could not achieve the desired success against CAE, due to its high costs. With similar indications, it is recommended that the CAE procedure, which is more cost effective from the perspective of the payers should be applied in treatment of carotid artery stenosis disease.

Anahtar Kelimeler

ICER, carotid artery stenosis disease, carotid artery stenting, carotid endarterectomy, cost-effectiveness

KAROTİS ENDARTEREKTOMİ VE KAROTİS ARTER STENTLEME YÖNTEMLERİNİN ÖDEYİCİ PERSPEKTİFİNDEN MALİYET-ETKİLİLİĞİNİN DEĞERLENDİRİLMESİ

Öz

Araştırmada karotis arter stenozu hastalığı (KrAH) tedavisinde karotis arter stentleme (KAS) ve karotis endarterektomi (KAE) yöntemlerinin maliyet etkililiğinin değerlendirilmesi amaçlanmıştır. Retrospektif ve kesitsel nitelikte olan bu araştırma, Ankara Üniversitesi İbni-Sina Hastanesi’nde 2019-2021 tarihleri arasında KrAH tanısı alan, KAS ve KAE yöntemleri ile tedavi olan 61 hastanın maliyet verileri analiz edilmiş ve hastalara EQ-5D-5L yaşam kalitesi ölçeği telefon ile uygulanmıştır. Hizmet başı ödeme kapsamında geri ödeme kurumu perspektifinden KAS ile tedavi olmanın ortalama hasta başına maliyeti 9.328,67₺, QALYs değeri ise 0,7974 birim; KAE ile tedavi olmanın ortalama hasta başına maliyeti 6.484,13₺, QALYs değeri ise 0,7887 birim olarak tespit edilmiştir. Araştırmada VAS skorları KAS yönteminde yaklaşık 0,79; KAE yönteminde ise 0,83 olarak bulunmuştur. Analiz sonucu İMEO değeri, kazanılan QALYs başına 326.958,62₺ olarak hesaplanmıştır. İMEO, maliyet etkililik düzleminde maliyet etkililik eşiğinin üstünde yer almıştır. Yıllık KrAH prevalansının %1,5 varsayımı altında KAS yönteminin bütçeye etkisi %4,51, KAE yönteminin bütçeye etkisi ise %3,14 olarak gerçekleşmiştir. Araştırmanın maliyet etkililik analizinde KAE yöntemi KAS yöntemine göre daha maliyet etkili olmuştur. Benzer endikasyonlara sahip olmak koşulu ile ödeyici kurum perspektifinden daha maliyet etkili olan KAE yönteminin tedavide uygulanması önerilmektedir.

Anahtar Kelimeler

İMEO, karotis arter stenozu hastalığı, karotis arter stentleme, karotis endarterektomi, maliyet etkililik

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