Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Other Publications
    • ajnr

User menu

  • Subscribe
  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

  • Subscribe
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds
Research ArticleInterventional

When Is Carotid Angioplasty and Stenting the Cost-Effective Alternative for Revascularization of Symptomatic Carotid Stenosis? A Canadian Health System Perspective

M.A. Almekhlafi, M.D. Hill, S. Wiebe, M. Goyal, D. Yavin, J.H. Wong and F.M. Clement
American Journal of Neuroradiology February 2014, 35 (2) 327-332; DOI: https://doi.org/10.3174/ajnr.A3682
M.A. Almekhlafi
aFrom the Departments of Clinical Neurosciences (M.A.A., M.D.H., S.W., M.G., D.Y., J.H.W.)
eDepartment of Internal Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
M.D. Hill
aFrom the Departments of Clinical Neurosciences (M.A.A., M.D.H., S.W., M.G., D.Y., J.H.W.)
bMedicine (M.D.H.)
cCommunity Health Sciences (M.D.H., S.W., F.M.C.)
dRadiology (M.G., M.D.H.), Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
S. Wiebe
aFrom the Departments of Clinical Neurosciences (M.A.A., M.D.H., S.W., M.G., D.Y., J.H.W.)
cCommunity Health Sciences (M.D.H., S.W., F.M.C.)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
M. Goyal
aFrom the Departments of Clinical Neurosciences (M.A.A., M.D.H., S.W., M.G., D.Y., J.H.W.)
dRadiology (M.G., M.D.H.), Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
D. Yavin
aFrom the Departments of Clinical Neurosciences (M.A.A., M.D.H., S.W., M.G., D.Y., J.H.W.)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
J.H. Wong
aFrom the Departments of Clinical Neurosciences (M.A.A., M.D.H., S.W., M.G., D.Y., J.H.W.)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
F.M. Clement
cCommunity Health Sciences (M.D.H., S.W., F.M.C.)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Supplemental
  • Info & Metrics
  • References
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Fig 1.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Fig 1.

    The Markov model structure.

  • Fig 2.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Fig 2.

    Scatterplot of the cost-effectiveness plane.

Tables

  • Figures
    • View popup
    Table 1:

    Clinical estimates for the periprocedural and annual outcomes

    OutcomePeriprocedural Risk (CI95) after CEAAnnual Risk (CI95) after CEAPeriprocedural OR (CI95) of CAS vs CEAAnnual OR (CI95) of CAS vs CEAReferences
    Death0.009 (0.008–0.01)0.018 (0.016–0.02)1.11 (0.82–1.40)1.02 (0.94–1.10)2,4,21,22,27,28
    Major stroke0.006 (0.005–0.008)0.013 (0.012–0.015)1.645 (0.89–2.1)1.1 (0.58–2.10)
    Minor stroke0.022 (0.019–0.025)0.0515 (0.05–0.052)1.91 (1.17–3.11)1.3 (0.75–2.08)
    MI0.018 (0.015–0.02)N/A0.47 (0.38–0.56)N/A
    • Note:—CI95 indicates 95% confidence interval; N/A, not available.

    • View popup
    Table 2:

    Cost estimates (2012)

    Base Case Cost Estimates (CDN$)Reference
    CAS procedure7303Calgary cohort
    CAS hospitalization2243
    CEA procedure4483
    CEA hospitalization3703
    Major stroke
        1st year83164BURST study16,29
        Annually after 1st year31267
    Minor stroke
        1st year31136BURST study16,29
        Annually after 1st year13488
    MI
        1st year4937Conly et al18
        Annually after 1st year1455
    Doppler US237Government of Alberta
    Clopidogrel (daily)1.18Government of Alberta
    • Note:—CDN$ indicates cost estimates; US, ultrasound.

    • View popup
    Table 3:

    Utility estimates

    Base Case Utility EstimateReference
    Baseline0.86Beaver Dam study19
    Healthy0.86
    MI0.74SAPPHIRE11
    Major stroke0.28Tengs and Linn meta-analysis20
    Minor stroke0.64
    Death0
    • View popup
    Table 4:

    Clinical characteristics of the local treatment cohorts

    Carotid Stenting (n = 134)Carotid Endarterectomy (n = 66)
    Mean age (yr) (SD)72.2 (8.5)69 (8.8)
    Women28.4 (38/134)22.7 (15/66)
    Risk factors
        Coronary artery disease45.5 (61/134)18.2 (12/66)
        Diabetes30.6 (40/134)43.9 (29/66)
        Hypertension88.1 (118/134)68.2 (45/66)
        Current smoking32.1 (43/134)31.8 (21/66)
    Qualifying event
        Retinal events18.7 (25/134)16.7 (11/66)
        TIA32.7 (44/134)39.4 (26/66)
        Stroke29.9 (40/134)25.7 (17/66)
        Asymptomatic18.7 (25/134)18.2 (12/66)
    • View popup
    Table 5:

    Base case and scenario analyses

    StrategyCostIncremental Cost ($)Effectiveness (QALYs)Incremental EffectivenessIncremental Cost-EffectivenessICER
    Base case
        CEA$24,6246.833605
        CAS$30,731$6107.006.71−0.124580Dominateda
    SAPPHIRE
        CEA$77,377$14,801.485.14−1.9615049Dominateda
        CAS$62,5767.18814
    EVA-3S
        CEA$225856.82$3312
        CAS$30,832$8246.386.67−0.15$4695Dominateda
    CREST
        CEA$22,2596.89$3227
        CAS$25,846$3587.006.63−0.27$3900Dominateda
    • Note:—ICER indicates incremental cost-effectiveness ratio.

    • ↵a “Dominated” means that the treatment modality was associated with more cost and less effectiveness.

PreviousNext
Back to top

In this issue

American Journal of Neuroradiology: 35 (2)
American Journal of Neuroradiology
Vol. 35, Issue 2
1 Feb 2014
  • Table of Contents
  • Index by author
  • Complete Issue (PDF)
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
When Is Carotid Angioplasty and Stenting the Cost-Effective Alternative for Revascularization of Symptomatic Carotid Stenosis? A Canadian Health System Perspective
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
When Is Carotid Angioplasty and Stenting the Cost-Effective Alternative for Revascularization of Symptomatic Carotid Stenosis? A Canadian Health System Perspective
M.A. Almekhlafi, M.D. Hill, S. Wiebe, M. Goyal, D. Yavin, J.H. Wong, F.M. Clement
American Journal of Neuroradiology Feb 2014, 35 (2) 327-332; DOI: 10.3174/ajnr.A3682

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
When Is Carotid Angioplasty and Stenting the Cost-Effective Alternative for Revascularization of Symptomatic Carotid Stenosis? A Canadian Health System Perspective
M.A. Almekhlafi, M.D. Hill, S. Wiebe, M. Goyal, D. Yavin, J.H. Wong, F.M. Clement
American Journal of Neuroradiology Feb 2014, 35 (2) 327-332; DOI: 10.3174/ajnr.A3682
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Purchase

Jump to section

  • Article
    • Abstract
    • ABBREVIATIONS:
    • Materials and Methods
    • Results
    • Discussion
    • Conclusions
    • Footnotes
    • References
  • Figures & Data
  • Supplemental
  • Info & Metrics
  • References
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Crossref
  • Google Scholar

This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.

More in this TOC Section

  • Middle Meningeal Artery Embolization Using Combined Particle Embolization and n-BCA with the Dextrose 5% in Water Push Technique for Chronic Subdural Hematomas: A Prospective Safety and Feasibility Study
  • Do Outcomes between Women and Men Differ after Endovascular Thrombectomy? A Meta-analysis
  • Propensity Score Analysis of Flow Diverters Placed in Scaffolding Stents
Show more INTERVENTIONAL

Similar Articles

Advertisement

News and Updates

  • Lucien Levy Best Research Article Award
  • Thanks to our 2020 Distinguished Reviewers
  • Press Releases

Resources

  • Evidence-Based Medicine Level Guide
  • How to Participate in a Tweet Chat
  • AJNR Podcast Archive
  • Ideas for Publicizing Your Research
  • Librarian Resources
  • Terms and Conditions

Opportunities

  • Share Your Art in Perspectives
  • Get Peer Review Credit from Publons
  • Moderate a Tweet Chat

American Society of Neuroradiology

  • Neurographics
  • ASNR Annual Meeting
  • Fellowship Portal
  • Position Statements

© 2021 by the American Society of Neuroradiology | Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire