Carotid artery stenting shown to be cost-effective alternative to endarterectomy

Mar 03, 2011

Researchers determined that carotid artery stenting (CAS) with embolic protection is an economically attractive alternative to endarterectomy (END) for patients at increased surgical risk. The study, based on data from the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial, found that initial procedural cost was higher with CAS, but post-procedure hospital stay was shorter which significantly offset associated costs compared to END. Details of the study—the first to evaluate the long-term cost-effectiveness of CAS versus END in stroke and heart attack prevention—are published in the March issue of Catheterization and Cardiovascular Interventions, a peer-reviewed journal of The Society for Cardiovascular Angiography and Interventions (SCAI).

According to the Centers for Disease Control and Prevention (CDC), stroke is the third leading cause of death and the leading cause of serious long-term disability in the U.S. The CDC estimates that stroke cost the U.S. roughly $74 billion in healthcare services, medications, and lost productivity in 2010. Prior studies established carotid END as the standard of care for prevention of stroke in patients with stenosis. However, the Food and Drug Administration (FDA) Circulatory System Devices Advisory Panel recently recommended expanding availability of CAS to patients with carotid artery disease at standard risk for surgical complications. The FDA recommendation and subsequent practice guidelines sponsored by 14 organizations, including SCAI, underscore the safety and efficacy of CAS as an option for patients needing revascularization.

In the current study, David Cohen, MD, and colleagues from St. Luke's Mid America Heart and Vascular Institute in Kansas City, Mo., evaluated the cost-effectiveness of CAS versus END using SAPPHIRE trial data. The SAPPHIRE trial included 310 patients with accepted indication for END but at high risk for complication who were then randomized and underwent CAS (n=159) or END (n=151). Researchers prospectively assessed clinical outcomes, resource use, costs and quality of life for all participants over a one-year period following the procedures.

"Our findings show that CAS with embolic protection offers a cost-effective alternative treatment option for patients with carotid artery atherosclerosis who are at high risk of adverse events with END," noted Dr. Cohen. Study results showed initial procedural costs were significantly higher for stenting ($7,000) than for END ($3,000). However, post-procedure hospital stay was one day shorter for CAS which reduced associated costs, resulting in initial costs for stenting being only $559 per patient higher than for END. Follow-up costs after discharge and total one-year costs did not differ between the two procedures.

Researchers also found after the first year, the rates of death, heart attack, major stroke and repeat carotid revascularization were lower with CAS compared with END (7% vs. 13%; 3% vs. 8%; 0.6% vs. 4%; 0.6% vs. 4%). Follow-up medical costs were $810 higher for stenting. "CAS appears to be a highly cost-effective option for high surgical risk patients," concluded Dr. Cohen. "Results should not be generalized to patients at low surgical risk, however. Further studies are needed to assess efficacy and cost-effectiveness of CAS in this patient population."

Explore further: Research shows that bacteria survive longer in contact lens cleaning solution than thought

More information: "Costs and Cost-Effectiveness of Carotid Stenting versus Endarterectomy for Patients at Increased Surgical Risk: Results From the SAPPHIRE Trial." Elizabeth Mahoney, Dan Greenberg, Tara Lavelle, Ronna Berezin, K. Ishak, J. Caro, Jay Yadav, William Gray, Mark Wholey and David Cohen. Catheterization and Cardiovascular Interventions; Published Online: February 22, 2011 (DOI: 10.1002/ccd.22869); Print Issue Date: March 2011.

add to favorites email to friend print save as pdf

Related Stories

New results in carotid artery stenosis versus endarterectomy

Dec 01, 2010

Doctors have long known that patients with carotid artery stenosis, narrowed blood vessels in the neck, are at significant risk for a stroke. The condition has severe implications. Annually, in the United States, 795,000 ...

Recommended for you

Malaysia quarantines 64 villagers over MERS virus

30 minutes ago

Malaysia has quarantined 64 people in a southern village after one of its residents become the country's first person to die of a respiratory illness that is spreading from the Middle East, local media reported Thursday.

Spate of Mideast virus infections raises concerns

1 hour ago

A recent spate of infections from a frequently deadly Middle East virus is raising new worries about efforts to contain the illness, with infectious disease experts urging greater vigilance in combatting ...

New MRSA superbug emerges in Brazil

1 hour ago

An international research team led by Cesar A. Arias, M.D., Ph.D., at The University of Texas Health Science Center at Houston (UTHealth) has identified a new superbug that caused a bloodstream infection ...

User comments : 0

More news stories

Turning off depression in the brain

Scientists have traced vulnerability to depression-like behaviors in mice to out-of-balance electrical activity inside neurons of the brain's reward circuit and experimentally reversed it – but there's ...

Spate of Mideast virus infections raises concerns

A recent spate of infections from a frequently deadly Middle East virus is raising new worries about efforts to contain the illness, with infectious disease experts urging greater vigilance in combatting ...

Clean air: Fewer sources for self-cleaning

Up to now, HONO, also known as nitrous acid, was considered one of the most important sources of hydroxyl radicals (OH), which are regarded as the detergent of the atmosphere, allowing the air to clean itself. ...

Thinnest feasible nano-membrane produced

A new nano-membrane made out of the 'super material' graphene is extremely light and breathable. Not only can this open the door to a new generation of functional waterproof clothing, but also to ultra-rapid filtration. The ...

There's something ancient in the icebox

Glaciers are commonly thought to work like a belt sander. As they move over the land they scrape off everything—vegetation, soil, and even the top layer of bedrock. So scientists were greatly surprised ...