Cost-effectiveness of Carotid Surgery

Ann Vasc Surg . 2019 May;57:177-186. doi: 10.1016/j.avsg.2018.09.013. Epub 2018 Nov 28.

Fecha de la publicación: 28/11/2018

Autor: Sandra Vicente Jiménez (1), Pilar Carrasco (2), Gil Rodriguez (3), Manuel Doblas (4), Antonio Orgaz (4), Angel Flores (4), Manuel Maynar (5), Jose A Gonzalez-Fajardo (6), Juan Fontcuberta (7)



1Department of Angiology and Vascular and Endovascular Surgery, Hospitales Sanitas, Madrid, Spain. Electronic address:

2Department of Economy, Hospital Virgen de la Salud, Toledo, Spain.

3Department of Stadistic and Epidemiology, Hospital Fundación de Alcorcon, Madrid, Spain.

4Department of Angiology and Vascular and Endovascular Surgery, Hospital Virgen de la Salud, Toledo, Spain.

5Department of Endoluminal Surgery, Hospital Santa Cruz de Tenerife, Hospiten, Santa Cruz de Tenerife, Spain.

6Department of Angiology and Vascular Surgery, Hospital Doce de Octubre, Madrid, Spain.

7Department of Angiology and Vascular and Endovascular Surgery, Hospitales Sanitas, Madrid, Spain.


Background: The purpose of this study is to determinate the cost-effectiveness of carotid endarterectomy (CEA) versus transfemoral stenting (TFS) and transcervical stenting (TCS) in a short- and long-term basis in symptomatic and asymptomatic patients.

Methods: From January 2003 to December 2014, patients from the vascular department, with symptomatic or asymptomatic carotid stenosis, who were clinically and anatomically suitable for TFS, TCS, or CEA, were included. Prospective cost data for each individual procedure and complication during follow-up were obtained from the diagnosis-related group. The quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios were estimated. Analysis of data was by treatment received. All statistical tests were two-sided. The significance level was 5%.

Results: A total of 349 patients were enrolled: 61 for CEA (17.5%), 159 for TFS (45.5%), and 129 for TCS (37%). A total of 220 (63%) patients were symptomatic and 129 (37%) were asymptomatic. The median procedural cost and overall cost were lower on CEA (5499€ and 5595€, respectively). However, QALYs, for symptomatic patients, were better on TCS (7.3), whereas for asymptomatic patients, QALYs were better on CEA (9.6). Cost-effectiveness for symptomatic patients was better with TCS (803€/QALY), and for asymptomatic patients, it was with CEA (654€/QALY).

Conclusions: TFS and TCS were associated with clinical outcomes equivalent to CEA on both symptomatic and asymptomatic patients. Cost-effectiveness ratios for symptomatic patients were better on TCS, whereas the CEA showed the best results in asymptomatic patients.