Cost-effectiveness of Carotid Bifurcation Resection and Interposition of a Polytetrafluoroethylene Graft versus Carotid Endarterectomy in Belgium: A Preliminary Study

Philippe De Vleeschauwer, Ian Diebels and Marc Dubois

Department of Thoracic and Vascular Surgery, Heilig-Hartziekenhuis, Belgium
Department of Medicine and Health Sciences, University of Antwerp, Belgium

^*Correspondance to: Philippe De Vleeschauwer 

 PDF  Full Text DOI: 10.25107/2474-1647.1300

Abstract

Introduction: Cerebrovascular disease is an important global health problem. The economic burden of stroke involves the direct hospital cost and the indirect long-term cost. In Europe the cost of ischemic stroke during the acute phase (first year) has been estimated to be 18,000-20,000 Euros. Moreover, the lifetime cost of stroke is approximately 50,000 Euros. If the stroke is due to significant carotid artery disease, different treatments are available. We present our preliminary results on the cost-effectiveness of Carotid Bifurcation Resection and Interposition of a Polytetrafluoroethylene Graft (BRIG) versus Carotid Endarterectomy (CEA).
Methods: A total of 60 patients were included, 30 BRIG and 30 Carotid endarterectomies (CEA). All CEA were performed by one surgeon, Dubois M. All BRIG procedures were performed by a single surgeon, Ph. De Vleeschauwer. Analysed costs were divided in total cost of hospital stay, the resource cost and pharmaceutical cost.Results: The results show that the total cost of hospital stay was similar in both groups: 3,124.90 for CEA vs. 3,178.46 for BRIG (p=0.81). The total hospital stay cost of the BRIG group was 53.56 Euros (1.7%) more than in the CEA group; however this result was statistically not significant. Nevertheless in Belgium we have to make a distinction in the choice of room namely between a single and twin room. If this single room group is ignored, the total hospital stay cost of the BRIG group is 480.92 Euro (19%) more expensive than the CEA group. There was a significant difference in material cost both as regards to the total cost as the cost for the patient and the national health insurance (150.64 Euro vs. 600.62 Euro, p< 0.01). On the other hand, the pharmaceutical expenses in the CEA group were 15.34 euro (11%, p=0.01) significantly higher compared to the BRIG group.Conclusion: The BRIG procedure has a higher overall cost, mainly due to the more expensive graft. However, the lower hospital morbidity and mortality as compared to the CEA are promising and suggest an overall cost reduction concerning stroke prevention. These preliminary results justify further research of the BRIG procedure.

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Cite the article

De Vleeschauwer P, Diebels I, Dubois M. Cost-effectiveness of Carotid Bifurcation Resection and Interposition of a Polytetrafluoroethylene Graft versus Carotid Endarterectomy in Belgium: A Preliminary Study. Clin Surg. 2017; 2: 1300.