This study compared the cost-effectiveness of carotid artery stent placement (CAS) versus carotid endarterectomy (CEA) in high-risk patients based on data from the SAPPHIRE trial. The mean cost per quality-adjusted life year (QALY) gained was higher for CAS ($16,223) than for CEA ($12,745). The incremental cost-effectiveness ratio estimated CAS to be $67,891 more expensive per QALY gained than CEA, with a wide range. Although CAS was not inferior to CEA for outcomes, its higher cost offsets the marginal benefit for high-risk patients.

3. Cost-Effectiveness Analysis of Protected Carotid Artery Stent Placement Versus Endarterectomy in High-Risk Patients

10. SAPPHIRE Trial 13.8% 17.0% COPD 35.3% 29.7% Myocardial Infarction 14.7% 24.1% Class 3-4 Angina 75.5% 85.8% Coronary Artery Disease Risk Factors 27.7% 29.9% Symptomatic 72.6 (46-91) 72.5 (49-89) Age (Years) 67.1% 66.9% Men 167 167 No of Patients CEA CAS Parameters

11. Model variables for outcome associated with CAS & CEA 5% 2% Non Q-wave 1% 0% Q-wave MI (at 30 Days) 2% 4% Minor 4% 1% Major Ipsilateral > 30 Days Stroke at 30 Days 13% 7% Death (1 Year) Clinical Input Variable CEA CAS Parameters