Akkara Yash, Hon Joshua J, Ahmed Mahathir, Musmar Basel, Roy Joanna, Tjoumakaris Stavropoula, Gooch Michael Reid, Rosenwasser Robert H, Jabbour Pascal
Imperial College School of Medicine, London, England.
Department of Neurological Surgery, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia, PA, USA.
Transl Stroke Res. 2025 Apr 11. doi: 10.1007/s12975-025-01347-z.
Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are gold-standard treatments of carotid artery stenosis. This study aims to identify the cost-effectiveness of CEA vs CAS.
Studies were screened through PubMed, MEDLINE, and Embase using PRISMA guidelines, and required ≥ 20 participants who were ≥ 16 years, alongside costs at 1-year postoperatively. The Shapiro-Wilk test, independent sample t-tests, ANOVA, and Spearman's R were used, with costs adjusted to 2024. A random-effects model was used to compare cost-effectiveness. Bias assessment was according to the Cochrane Risk of Bias 2.0 tool and the Newcastle-Ottawa Scale.
7 studies were included, with a sample of 6493 participants (3418 M, 3075 F). 2932 and 3511 participants underwent CEA and CAS respectively. CEA reported a significantly longer mean length of procedure (191.92 vs. 77.5 min, p < 0.0001) and length of stay (3.13 vs. 2.60 days, p < 0.0001) vs. CAS. The mean adjusted cost of CEA and CAS were $18156.60 (6466) and $17711.01 (5511) respectively. Studies reported lower risks of stroke (2.12% vs. 3.65%, p < 0.001), higher risks of myocardial infarctions (1.70% vs. 1.42%, p < 0.01), and higher risks of other complications for CEA vs. CAS respectively. The expected 1-year cost of CEA was marginally lower than CAS ($21264.03 vs. $21433.14, p < 0.05). The cost-effectiveness of CEA was marginally better than CAS (ratio = 1.019, 95% CI [1.017, 1.020)].
CEA provides marginally improved cost-effectiveness over CAS, providing long-term cost benefits to centers with large surgical volumes. However, shorter procedural times and inpatient stays with CAS may improve overall productivity. Cost should hence not be a deciding factor when choosing between CEA and CAS.
颈动脉支架置入术（CAS）和颈动脉内膜切除术（CEA）是颈动脉狭窄的金标准治疗方法。本研究旨在确定CEA与CAS的成本效益。
按照PRISMA指南在PubMed、MEDLINE和Embase中筛选研究，要求研究对象≥16岁且≥20名参与者，并提供术后1年的费用数据。使用Shapiro-Wilk检验、独立样本t检验、方差分析和Spearman相关系数R进行分析，费用数据调整至2024年水平。采用随机效应模型比较成本效益。根据Cochrane偏倚风险2.0工具和纽卡斯尔-渥太华量表进行偏倚评估。
纳入7项研究，样本量为6493名参与者（男性3418名，女性3075名）。分别有2932名和3511名参与者接受了CEA和CAS治疗。与CAS相比，CEA的平均手术时间（191.92分钟对77.5分钟，p<0.0001）和住院时间（3.13天对2.60天，p<0.0001）显著更长。CEA和CAS的平均调整后费用分别为18156.60美元（6466美元）和17711.01美元（5511美元）。研究报告显示，CEA的中风风险较低（2.12%对3.65%，p<0.001），心肌梗死风险较高（1.70%对1.42%），其他并发症风险也高于CAS。CEA的预期1年成本略低于CAS（21264.03美元对21433.14美元，p<0.05）。CEA的成本效益略优于CAS（比值=1.019，95%CI[1.017,1.020]）。
CEA的成本效益略优于CAS，为手术量大的中心提供了长期成本效益。然而，CAS较短的手术时间和住院时间可能会提高整体效率。因此，在选择CEA和CAS时，成本不应成为决定因素。
