Cost-Effectiveness of Carotid Artery Stenting Compared to Carotid Endarterectomy in Patients with Carotid Stenosis: A Turkish Health System Perspective

Objective: This study assesses the cost-effectiveness of carotid artery stenting (CAS) versus carotid endarterectomy (CAE) from the perspective of payers in Türkiye, considering potential complications. Methods: A decision tree analysis model was employed using data from 61 patients (29 CAS, 32 CAE) treated for carotid stenosis (CS) between 2019-2021. The procedural costs were derived from a university hospital-billing department, while health outcomes such as any stroke and myocardial infarction (MI) and their utility values were based on meta-analyses and established studies. The primary outcome measure was the incremental cost-effectiveness ratio (ICER). Results: When the model was applied, CAS incurred higher costs ( USD per patient) compared to CAE (USD 947,30), resulting in an ICER of USD 96.345 per QALY. CAE, as a traditional model, demonstrated dominance due to its lower costs and slightly better outcomes. Sensitivity analysis showed that a ±10% change in input parameters, particularly a higher impact was observed in costs and stroke incidence and could alter the ICER about ± USD 1.225 to 3.500. Budget impact analysis estimated CAS and CAE affecting 4.37% and 3.09% of the healthcare budget, respectively. Conclusion: CAE demonstrated superior cost-effectiveness over CAS in treating CS within the Turkish healthcare system. Despite CAS's appeal as a less invasive option, its higher costs and marginal effectiveness suggest that CAE should be prioritized unless parameters such as procedural costs and any stroke risks associated with CAS are reduced.