Janssen M P, de Borst G J, Mali W P Th M, Kappelle L J, Moll F L, Ackerstaff R G A, Rothwell P M, Brown M M, van Sambeek M R, Buskens E
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Eur J Vasc Endovasc Surg. 2008 Sep;36(3):258-64; discussion 265-6. doi: 10.1016/j.ejvs.2008.05.008. Epub 2008 Jul 22.
Carotid Angioplasty combined with Stenting (CAS) is increasingly performed because of its presumed benefits. A study was performed to identify key factors that determine the cost-effectiveness as compared to conventional carotid endarterectomy (CEA).
The incremental cost-effectiveness of CAS over CEA for different scenarios was estimated using a modeling approach. Treatment costs were based on actual costs of successful procedures whereas costs of complications were taken from the literature. Patient survival was modeled using the endarterectomy patients from the ECST trial.
Procedural costs of CAS are higher than those of CEA, mainly as a result of the high material costs. Cost-effectiveness of CAS primarily depends on major stroke rates. One percent increase in the peri-operative major stroke rate causes a cost increase of 1051 euros and a loss of 0.06 quality adjusted life years.
At present CAS is at best non-inferior to CEA in terms of clinical outcome. Cost savings due to shorter admission are offset by the high costs associated with catheter-based interventions. At present CAS should be restricted to controlled settings until clinical trials have shown a substantial clinical benefit.
由于颈动脉血管成形术联合支架置入术（CAS）被认为具有诸多益处，其应用越来越广泛。本研究旨在确定与传统颈动脉内膜切除术（CEA）相比，决定该手术成本效益的关键因素。
采用建模方法评估不同情况下CAS相对于CEA的增量成本效益。治疗成本基于成功手术的实际成本，而并发症成本则来自文献。使用欧洲颈动脉外科试验（ECST）中的内膜切除术患者对患者生存率进行建模。
CAS的手术成本高于CEA，主要是由于材料成本高昂。CAS的成本效益主要取决于主要卒中发生率。围手术期主要卒中发生率每增加1%，成本增加1051欧元，质量调整生命年损失0.06。
目前，就临床结果而言，CAS至多不劣于CEA。住院时间缩短带来的成本节约被基于导管介入治疗的高昂成本所抵消。目前，在临床试验显示出显著的临床益处之前，CAS应限于在可控环境下使用。
