Cost-Effectiveness of TCAR Versus CEA Evaluated in Simulation Model

December 30, 2021—A cost-effectiveness analysis comparing transcarotid artery revascularization (TCAR) with carotid endarterectomy (CEA) for carotid artery stenosis found that although 5-year costs for TCAR were greater, TCAR afforded greater quality-adjusted life years (QALYs) than CEA. The analysis was published in Journal of Vascular Surgery (2021;74:1910-1918.E3).

Principal author Mahmoud B. Malas, MD, et al explained in the announcement that although the clinical benefits of TCAR have been established, little is known about its cost-effectiveness compared to CEA.

Therefore, investigators sought to compare the quality of life, efficacy, and cost-effectiveness for patients undergoing TCAR versus CEA. Using a Markov microsimulation model, the outcomes of 10,000 symptomatic patients undergoing either TCAR or CEA were simulated to analyze QALYs, costs, and incremental cost-effectiveness ratio (ICER) over a 5-year period.

As reported by the Society for Vascular Surgery (SVS), QALY was defined as the product of time and patient quality of life (scale, 0-1). Cost-effectiveness was measured with the ICER, which was calculated as the incremental costs divided by incremental QALYs, and defined as an ICER < $150,000/QALY.

The 5-year costs per procedure were $7,821 per 2.85 QALY for CEA and $19,154 per 2.92 QALY for TCAR, resulting in an ICER of $152,229 over 5 years in the TCAR arm. SVS noted that TCAR was considered cost-effective 49% of the time.

“The present study utilizes microsimulation models to compare the cost, efficacy, and cost-effectiveness of TCAR versus CEA in symptomatic patients,” commented Dr. Malas to SVS. “Although the 5-year costs for TCAR were approximately $11,000 greater than those for CEA, it afforded greater QALYs and may be cost-effective in the long term.”

The SVS announcement concluded that new technology can be associated with a significant cost when introduced, but it is likely that the clinical benefits of TCAR will prove cost-effective as the procedure becomes more common and its costs decrease.