School of Medicine, University of California San Diego, La Jolla, Calif.
Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, Calif.
J Vasc Surg. 2021 Dec;74(6):1910-1918.e3. doi: 10.1016/j.jvs.2021.05.051. Epub 2021 Jun 26.
Recent studies have demonstrated that transcarotid artery revascularization (TCAR) has comparable outcomes to the surgical gold standard, carotid endarterectomy (CEA). However, few studies have analyzed the cost of TCAR, and no study has evaluated its cost-effectiveness. The purpose of this study is to conduct a cost-effectiveness analysis comparing TCAR with CEA for carotid artery stenosis.
We built a Markov microsimulation using transition probabilities and utilities from existing literature for symptomatic patients undergoing TCAR or CEA. Costs were derived from literature then converted to 2019 dollars. The model included six health states with monthly cycle lengths: surgery, death, alive after surgery, alive after myocardial infarction, alive after stroke, and alive after stroke and death. Quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratio (ICER) were analyzed over a 5-year period. One-way sensitivity and probabilistic sensitivity analyses were conducted to study the impact of parameter variability on cost effectiveness.
For symptomatic patients, CEA cost $7821 for 2.85 QALYs, whereas TCAR cost $19154 for 2.92 QALYs, leading to an ICER of $152,229 per QALY gained in the TCAR arm. Sensitivity analysis demonstrated that our model was most sensitive to probability of restenosis, costs of TCAR, and costs of CEA. Probabilistic sensitivity analysis demonstrated TCAR would be considered cost-effective in 49% of iterations.
This study found that, although 5-year costs for TCAR were greater than CEA, TCAR afforded greater QALYs than CEA. TCAR became cost-effective at 6 years of follow-up.
最近的研究表明，经颈动脉血管重建术（TCAR）与手术金标准颈动脉内膜切除术（CEA）的结果相当。然而，很少有研究分析 TCA 的成本，也没有研究评估其成本效益。本研究旨在对颈动脉狭窄患者进行 TCA 与 CEA 的成本效益分析。
我们使用来自现有文献的转移概率和效用构建了一个 Markov 微模拟，用于进行 TCA 或 CEA 的有症状患者。成本来自文献，然后转换为 2019 年的美元。该模型包括六个健康状态，每月周期长度为：手术、死亡、手术后存活、心肌梗死后存活、中风后存活和中风后死亡。在 5 年内分析了质量调整生命年（QALY）、成本和增量成本效益比（ICER）。进行了单因素敏感性分析和概率敏感性分析，以研究参数变异性对成本效益的影响。
对于有症状的患者，CEA 的成本为 7821 美元，可获得 2.85 个 QALY，而 TCA 的成本为 19154 美元，可获得 2.92 个 QALY，导致 TCA 组每获得一个 QALY 的增量成本效益比为 152229 美元。敏感性分析表明，我们的模型对再狭窄概率、TCAR 成本和 CEA 成本最为敏感。概率敏感性分析表明，在 49%的迭代中，TCAR 被认为具有成本效益。
本研究发现，尽管 TCA 的 5 年成本高于 CEA，但 TCA 提供的 QALY 多于 CEA。TCAR 在 6 年随访时具有成本效益。
