December 12, 2008

Cost Analysis of Carotid Endarterectomy and Stenting

M. Ashraf Mansour, M.D., B Seth DeCamp, MD, Jason D. Slaikeu, MD, Chris M. Chambers, MD, Jill M. Gorsuch, MD.
Spectrum Health, Grand Rapids, MI, USA.

Background: Carotid endarterectomy (CEA) is the most common open vascular procedure, however, carotid angioplasty and stenting (CAS) appears to be replacing it in many practices. To date, there are no level I studies proving that CAS is better than CEA in standard risk patients.
Purpose: The study objective is to analyze the cost implications, to surgeons and hospitals, in the treatment of carotid stenosis.
Patients & Methods: We queried our database for all carotid procedures performed in a 3-year period. Patient characteristics, clinical presentation, type of procedure performed and outcomes were analyzed. Financial data on physician and hospital reimbursement for each procedure were obtained.
Results: During the study period, there were 182 CEAs in 172 patients (61 women and 111 men; average age 74) performed and 77 CAS in 69 patients (30 women and 39 men; average age 70). There were no significant differences in the complication rates in the two groups (one stroke in each group and one TIA in the CEA group). There were no deaths. Depending on the health insurance carrier, surgeons fees for CEA ranged from $790.97 to $1,401.48, and for CAS $844.35 to $1,314.21. Hospital reimbursement for CEA (DRG 037 and 038) ranged from $7,665 to $20,476 and for CAS (DRG 034 & 035) ranged from $11,798 to $17,561. However, hospital charges for uncomplicated CEA averaged $9,866 and for uncomplicated CAS $15,996.
Conclusion: In this study, carotid stenting is equivalent to endarterectomy in clinical outcomes. Physician reimbursement is not different for the two procedures, however, the hospital margin of profit is greatly reduced with CAS.

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