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Direct Supply Cost And Complication Analysis Of Transfemoral Carotid Stenting Versus Carotid Endarterectomy Versus Transcarotid Artery Revascularization - A Single Center Retrospective Study
Sarah Wenyon, BA, MPhil, Antony Fuleihan, BA, Melissa Xu, BA, Jovial Jospeh, BA, Natalie Walker, BA, Marissa Witmer, BA, Michael Nooromid, MD, Babak Abai, MD.
Thomas Jefferson University, Philadelphia, PA, USA.
OBJECTIVES - Assessing the cost-effectiveness of carotid stenosis interventions is essential in value-based care. This study compares the direct supply costs and complication rates of transfemoral carotid stenting (CAS), carotid endarterectomy (CEA), and transcarotid artery revascularization (TCAR) at a single center from 2016 to 2024.
METHODS - A retrospective review was conducted on patients who underwent tfCAS, CEA, or TCAR between January 1, 2016, and December 31, 2024, using relevant CPT codes. Demographic data, patient history, and complication rates—including stroke, myocardial infarction (MI), restenosis, and mortality—were tracked. Direct supply cost was collected from the finance department records. Length of stay (LOS) and direct supply costs were primary outcomes. Secondary endpoints included persistent hypotension (>24 hours), unexpected intubation within 72 hours of surgery, bleeding within 72 hours of surgery, TIA within 30 days, cardiac arrest within 30 days, embolism within 30 days, dissection within 72 hours, and death.
RESULTS - Preliminary analysis yielded 1224 patients, of these 390 were reviewed and 375 met inclusion criteria with an intervention date from January 1, 2016 to December 31, 2020. Among these, 54.5% underwent tfCAS, 35.7% CEA, and 9.6% TCAR. Direct supply costs were highest for TCAR ($4754.70), followed by tfCAS ($4101.60), and lowest for CEA ($1942.80). Hospital LOS was 1.3x longer for tfCAS compared to CEA and 2.4x longer than TCAR. A significant difference in stroke rates was observed across procedures (X2 (2, N = 375) = 6.71, p = 0.035), with tfCAS showing higher stroke risk compared to CEA (OR = 2.52, p = 0.036). Neurosurgeons performed 95.6% of tfCAS cases, with 86.3% of these being symptomatic patients.
CONCLUSION - Our preliminary results show that at our institution, tfCAS was the most common intervention but had significantly higher costs and longer LOS compared to CEA. TCAR, though more expensive, had shorter hospital stays. The direct supply costs of TCAR are 2.4x the cost of CEA. The direct supply costs of tfCAS is 2.1x the cost of CEA. These findings emphasize the need to consider both costs and outcomes when selecting interventions for carotid stenosis. Further analysis of symptomatic versus asymptomatic patients is warranted to fully assess the value of each procedure.
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