Carotid Stenting Versus Endarterectomy in Symptomatic Patients with ≥50% Stenosis: Cost-Effective Options in Patients Aged <70 and ≥70 Years

초록

The Carotid Revascularization Endarterectomy versus Stenting Trial showed that the relative efficacy of carotid artery stenting (CAS) and carotid endarterectomy (CEA) differs according to patient age. We assessed the cost-effectiveness of CAS vs. CEA in patients aged <70 years and ≥70 years with symptomatic stenosis ≥50%. Methods: Cost-effectiveness analysis was conducted using a Markov model over a lifetime from the Korean healthcare system perspective. Clinical effectiveness was estimated based on a multi-center retrospective cohort study. Costs were calculated using resource use and national health insurance claims data. Health utility weight was assessed using survey data. Results: In the base-case analysis, quality-adjusted life-years (QALYs) for CAS and CEA were 6.49 and 6.71, respectively. The incremental cost of CAS was $1536comparedwithCEA.CEAwasdominatedoptioninpatientswithsymptomaticstenosis\ge 50$411 less while increasing QALYs by 0.27; in patients aged ≥70 years, CAS cost $3392 more and decreased QALYs by 0.64. Probabilistic sensitivity analyses indicated that CAS would be a cost-effective option in 90.3% of patients aged <70 years and in 7.6% of patients aged ≥70 years. Conclusion: Patient age should be considered when deciding on treatment option for symptomatic stenosis. We believe that CEA would be a cost-effective option in patients aged ≥70 years, whereas CAS could be preferred in patients aged <70 years.

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