Cost-Utility Analysis Compares CAS Versus CEA in the International Carotid Stenting Study

May 10, 2016—A comparison of the cost effectiveness of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) using data from the International Carotid Stenting Study (ICSS) was published by Prof. Stephen Morris, PhD, et al in the International Journal of Stroke (2016;11:446–453).

ICSS is a multicenter randomized trial that randomly allocated patients with symptomatic carotid artery stenosis to treatment by CAS or CEA. Economic evidence comparing these treatments is limited and inconsistent, noted the investigators.

As summarized in the International Journal of Stroke, the investigators performed a cost-utility analysis estimating mean costs and quality-adjusted life-years per patient for both treatments over a 5-year time horizon based on resource use data and utility values collected in the trial. Costs of managing stroke events were estimated using individual patient data from the Oxford Vascular Study, a United Kingdom population-based study.

The investigators reported that the mean costs per patient were $10,477 in the CAS group (n = 853) and $9,669 in the CEA group (n = 857). There were no differences in mean quality-adjusted life-years per patient (3.247 vs 3.228). There were no differences in adjusted costs between groups (mean incremental costs for CAS vs CEA, $736) or adjusted outcomes (mean quality-adjusted life-years gained, −0.01).

The incremental net monetary benefit for CAS versus CEA was not significantly different from zero at the maximum willingness to pay for a quality-adjusted life-year commonly used in the UK. Sensitivity analyses showed little uncertainty in these findings.

Economic considerations should not affect whether patients with symptomatic carotid stenosis undergo CAS or CEA, concluded the investigators in the International Journal of Stroke.