Article Figures & Data
Figures
- Fig 1.
The Markov model structure.
- Fig 2.
Scatterplot of the cost-effectiveness plane.
Tables
Outcome Periprocedural Risk (CI95) after CEA Annual Risk (CI95) after CEA Periprocedural OR (CI95) of CAS vs CEA Annual OR (CI95) of CAS vs CEA References Death 0.009 (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 stroke 0.006 (0.005–0.008) 0.013 (0.012–0.015) 1.645 (0.89–2.1) 1.1 (0.58–2.10) Minor stroke 0.022 (0.019–0.025) 0.0515 (0.05–0.052) 1.91 (1.17–3.11) 1.3 (0.75–2.08) MI 0.018 (0.015–0.02) N/A 0.47 (0.38–0.56) N/A Note:—CI95 indicates 95% confidence interval; N/A, not available.
Base Case Cost Estimates (CDN$) Reference CAS procedure 7303 Calgary cohort CAS hospitalization 2243 CEA procedure 4483 CEA hospitalization 3703 Major stroke 1st year 83164 BURST study16,29 Annually after 1st year 31267 Minor stroke 1st year 31136 BURST study16,29 Annually after 1st year 13488 MI 1st year 4937 Conly et al18 Annually after 1st year 1455 Doppler US 237 Government of Alberta Clopidogrel (daily) 1.18 Government of Alberta Note:—CDN$ indicates cost estimates; US, ultrasound.
Base Case Utility Estimate Reference Baseline 0.86 Beaver Dam study19 Healthy 0.86 MI 0.74 SAPPHIRE11 Major stroke 0.28 Tengs and Linn meta-analysis20 Minor stroke 0.64 Death 0 Carotid Stenting (n = 134) Carotid Endarterectomy (n = 66) Mean age (yr) (SD) 72.2 (8.5) 69 (8.8) Women 28.4 (38/134) 22.7 (15/66) Risk factors Coronary artery disease 45.5 (61/134) 18.2 (12/66) Diabetes 30.6 (40/134) 43.9 (29/66) Hypertension 88.1 (118/134) 68.2 (45/66) Current smoking 32.1 (43/134) 31.8 (21/66) Qualifying event Retinal events 18.7 (25/134) 16.7 (11/66) TIA 32.7 (44/134) 39.4 (26/66) Stroke 29.9 (40/134) 25.7 (17/66) Asymptomatic 18.7 (25/134) 18.2 (12/66) Strategy Cost Incremental Cost ($) Effectiveness (QALYs) Incremental Effectiveness Incremental Cost-Effectiveness ICER Base case CEA $24,624 6.83 3605 CAS $30,731 $6107.00 6.71 −0.12 4580 Dominateda SAPPHIRE CEA $77,377 $14,801.48 5.14 −1.96 15049 Dominateda CAS $62,576 7.1 8814 EVA-3S CEA $22585 6.82 $3312 CAS $30,832 $8246.38 6.67 −0.15 $4695 Dominateda CREST CEA $22,259 6.89 $3227 CAS $25,846 $3587.00 6.63 −0.27 $3900 Dominateda Note:—ICER indicates incremental cost-effectiveness ratio.
↵a “Dominated” means that the treatment modality was associated with more cost and less effectiveness.
In this issue
When Is Carotid Angioplasty and Stenting the Cost-Effective Alternative for Revascularization of Symptomatic Carotid Stenosis? A Canadian Health System Perspective
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