A COST COMPARISON OF BALLOON ANGIOPLASTY AND STENTING VERSUS ENDARTERECTOMY FOR THE TREATMENT OF CAROTID-ARTERY STENOSIS

Purpose: Percutaneous transluminal angioplasty with stenting (PTAS) of the carotid artery has been advocated as an alternative treatment for high-grade stenosis. Rationale for this approach includes less morbid ity, shorter recovery, and lower cost when compared with carotid endar terectomy (CEA). Methods: The clinical results and hospital charges of patients who underwent elective treatment for carotid stenosis were r eviewed. During a concurrent 14-month period, 218 patients were admitt ed 229 times for 234 procedures for the treatment of 239 carotid bifur cation stenoses, 109 by PTAS and 130 by CEA. Hospital charges were rev iewed for each hospitalization and were categorized according to radio logy, operating room, cardiac catheterization laboratory, and all othe r hospital charges. Results: The combined incidence of postprocedure s trokes and deaths were: PTAS, eight strokes (7.7%) and one death (0.9% ); CEA, two strokes (1.5%) and two deaths (1.5%). Total hospital charg es per admission for the two groups were $30,140 for PTAS and $21,670 for CEA. The average postprocedure length of stay for PTAS was 2.9 day s (median, 2 days) and for CEA was 3.1 days (median, 3 days). Cardiac catheterization laboratory charges for the PTAS group were $12,968, wh ereas the operating room charges for the CEA group were $4263. When ho spitalizations that were extended by complications were excluded, the average total charges for the PTAS group (n = 84) dropped to $24,848 ( mean length of stay, 1.9 days) and for the CEA group (n = 111) to $19, 247 (mean length of stay 2.6 days). Conclusions: After evaluating hosp ital charges, PTAS for the treatment of carotid stenosis cannot curren tly be justified on the basis of reduced costs alone. With future cost -containing measures, total hospital charges can be reduced in both gr oups. (J Vasc Surg 1998;27:16-24.).