Carotid endarterectomy is less expensive than transcarotid artery revascularization

Abstract

Objective

Transcarotid artery revascularization (TCAR) is safe and effective for treatment of carotid stenosis, with comparable short-term outcomes with carotid endarterectomy (CEA). Few peer-reviewed studies evaluated the comparative costs of these two procedures. The objective of this study was to compare the costs of these procedures at a single institution.

Methods

This was a retrospective analysis of patients receiving TCAR or CEA at a single tertiary care center from August 2018 to July 2023. Patient characteristics, demographics, and procedure cost data were extracted from the electronic medical record. Stay costs were calculated using estimates derived from literature and adjusted for inflation. A subset of patient charts from June 2022 to July 2023 were used to calculate a baseline procedure cost for the TCAR and CEA cohorts, with individual implant cost from each chart added to obtain estimated procedure cost. Patients with insufficient chart data or who were converted from TCAR to CEA were excluded from analysis.

Results

Of 187 patients, 51 received TCAR and 136 received CEA. Patients undergoing TCAR were significantly older (74 vs 70 years; P = .007) and more likely to have a history of prior ipsilateral carotid intervention (9.8% vs 0.7%; P = .003), contralateral carotid intervention (18% vs 13%; P = .003), or neck surgery (35% vs 18%; P = .01). Procedure length was shorter in the TCAR group (104 vs 130 minutes; P = .002). No differences were found between TCAR and CEA in postoperative rates of stroke, myocardial infarction, or in-hospital mortality. Of the 56 patients for whom procedure cost data was collected, TCAR was found to have a higher procedure cost ($9114 for TCAR; $1409 for CEA; P < .001) and higher net hospitalization cost ($14,090 for TCAR; $7512 for CEA; P < .001). In the entire cohort, there were no differences in duration of post-procedure intensive care unit stay (1.5 vs 2.88 days; P = .2), hospital stay (2.18 vs 1.96 days; P = .4), or in stay cost ($5525 vs $5178; P = .06). There were significant differences in estimated procedure cost ($9100 for TCAR; $1412 for CEA; P < .001) and estimated net hospitalization cost ($14,625 for TCAR; $6591 for CEA; P < .001).

Conclusions

This study found that the cost to undergo TCAR was significantly higher than CEA at this institution. When factored into the net cost of hospitalization, TCAR more than doubled the net cost of perioperative stay. Further analysis is warranted to determine areas of cost optimization for carotid revascularization.