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KMID : 1146320190070020126
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Journal of Health Technology Assessment
2019 Volume.7 No. 2 p.126 ~ p.133
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Carotid Stenting Versus Endarterectomy in Symptomatic Patients with ≥50% Stenosis: Cost-Effective Options in Patients Aged <70 and ≥70 Years
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Oh Sung-Hee
Park Ji-Jeong
Lee Ja-Youn
Jeon Pyung
Cho Yong-Pil
Kim Tae-Sun
Kim Byung-Moon
Park Hyeon-Seon
Shin Sang-Jin
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Abstract
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Objectives: The Carotid Revascularization Endarterectomy versus Stenting Trial showed that therelative efficacy of carotid artery stenting (CAS) and carotid endarterectomy (CEA) differs accordingto patient age. We assessed the cost-effectiveness of CAS vs. CEA in patients aged <70 years and ≥70years with symptomatic stenosis ≥50%.
Methods: Cost-effectiveness analysis was conducted usinga 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 CEAwere 6.49 and 6.71, respectively. The incremental cost of CAS was $1536 compared with CEA. CEAwas dominated option in patients with symptomatic stenosis ≥50%. However, in patients aged <70years, CAS cost $411 less while increasing QALYs by 0.27; in patients aged ≥70 years, CAS cost $3392more and decreased QALYs by 0.64. Probabilistic sensitivity analyses indicated that CAS would be acost-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 CAScould be preferred in patients aged <70 years.
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KEYWORD
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Cost-benefit analysis, Cost-utility analysis, Endarterectomy, Stenting, Carotid artery stenosis
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