{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T04:11:19Z","timestamp":1773115879091,"version":"3.50.1"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2012,9]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) demonstrated similar rates of the primary composite end point between carotid artery stenting (CAS) and carotid endarterectomy (CEA), although the risk of stroke was higher with CAS, and the risk of myocardial infarction was higher with CEA. Given the large number of patients who are candidates for these procedures, an understanding of their relative cost and cost-effectiveness may have important implications for health care policy and treatment guidelines.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>We performed a formal economic evaluation alongside the CREST trial. Costs were estimated from all trial participants over the first year of follow-up using a combination of resource use data and hospital billing data. Patient-level health use scores were obtained using data from the SF-36. We then used a Markov disease-simulation model calibrated to the CREST results to project 10-year costs and quality-adjusted life expectancy for the 2 treatment groups.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>Although initial procedural costs were $1025\/patient higher with CAS, postprocedure costs and physician costs were lower such that total costs for the index hospitalization were similar for the CAS and CEA groups ($15 055 versus $14 816; mean difference, $239\/patient; 95% CI for difference, \u2212$297 to $775). Neither follow-up costs after discharge nor total 1-year costs differed significantly. For the CREST population, model-based projections over a 10-year time horizon demonstrated that CAS would result in a mean incremental cost of $524\/patient and a reduction in quality-adjusted life expectancy of 0.008 years compared with CEA. Probabilistic sensitivity analysis demonstrated that CEA was economically attractive at an incremental cost-effectiveness threshold of $50 000\/quality-adjusted life-year gained in 54% of samples, whereas CAS was economically attractive in 46%.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Despite slightly lower in-trial costs and lower rates of stroke with CEA compared with CAS, projected 10-year outcomes from this controlled clinical trial demonstrate only trivial differences in overall healthcare costs and quality-adjusted life expectancy between the 2 strategies. If the CREST results can be replicated in clinical practice, these findings suggest that factors other than cost-effectiveness should be considered when deciding between treatment options for carotid artery stenosis in patients at standard risk for surgical complications.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/clinicaltrials.gov\">http:\/\/clinicaltrials.gov<\/jats:ext-link>\n              . Unique Identifier: NCT00004732.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.112.661355","type":"journal-article","created":{"date-parts":[[2012,7,21]],"date-time":"2012-07-21T10:35:48Z","timestamp":1342866948000},"page":"2408-2416","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":60,"title":["Costs and Cost-Effectiveness of Carotid Stenting Versus Endarterectomy for Patients at Standard Surgical Risk"],"prefix":"10.1161","volume":"43","author":[{"given":"Katherine R.","family":"Vilain","sequence":"first","affiliation":[{"name":"From the Saint Luke's Mid America Heart Institute, Kansas City, MO (K.R.V., E.A.M., H.L., D.J.C.); University of Missouri, Kansas City, MO (E.A.M., D.J.C.); Oregon Health and Science University, Portland, OR (W.M.C.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Vascular Specialty Center, Baton Rouge, LA (A.D.S.); Ochsner Health System, New Orleans, LA (W.C.S.); the University of Southern California, Los Angeles, CA (F.A.W.); Columbia University, New York, NY (W.A.G..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth A.","family":"Magnuson","sequence":"additional","affiliation":[{"name":"From the Saint Luke's Mid America Heart Institute, Kansas City, MO (K.R.V., E.A.M., H.L., D.J.C.); University of Missouri, Kansas City, MO (E.A.M., D.J.C.); Oregon Health and Science University, Portland, OR (W.M.C.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Vascular Specialty Center, Baton Rouge, LA (A.D.S.); Ochsner Health System, New Orleans, LA (W.C.S.); the University of Southern California, Los Angeles, CA (F.A.W.); Columbia University, New York, NY (W.A.G..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haiyan","family":"Li","sequence":"additional","affiliation":[{"name":"From the Saint Luke's Mid America Heart Institute, Kansas City, MO (K.R.V., E.A.M., H.L., D.J.C.); University of Missouri, Kansas City, MO (E.A.M., D.J.C.); Oregon Health and Science University, Portland, OR (W.M.C.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Vascular Specialty Center, Baton Rouge, LA (A.D.S.); Ochsner Health System, New Orleans, LA (W.C.S.); the University of Southern California, Los Angeles, CA (F.A.W.); Columbia University, New York, NY (W.A.G..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wayne M.","family":"Clark","sequence":"additional","affiliation":[{"name":"From the Saint Luke's Mid America Heart Institute, Kansas City, MO (K.R.V., E.A.M., H.L., D.J.C.); University of Missouri, Kansas City, MO (E.A.M., D.J.C.); Oregon Health and Science University, Portland, OR (W.M.C.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Vascular Specialty Center, Baton Rouge, LA (A.D.S.); Ochsner Health System, New Orleans, LA (W.C.S.); the University of Southern California, Los Angeles, CA (F.A.W.); Columbia University, New York, NY (W.A.G..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard J.","family":"Begg","sequence":"additional","affiliation":[{"name":"From the Saint Luke's Mid America Heart Institute, Kansas City, MO (K.R.V., E.A.M., H.L., D.J.C.); University of Missouri, Kansas City, MO (E.A.M., D.J.C.); Oregon Health and Science University, Portland, OR (W.M.C.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Vascular Specialty Center, Baton Rouge, LA (A.D.S.); Ochsner Health System, New Orleans, LA (W.C.S.); the University of Southern California, Los Angeles, CA (F.A.W.); Columbia University, New York, NY (W.A.G..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"II","given":"Albert D.","family":"Sam","sequence":"additional","affiliation":[{"name":"From the Saint Luke's Mid America Heart Institute, Kansas City, MO (K.R.V., E.A.M., H.L., D.J.C.); University of Missouri, Kansas City, MO (E.A.M., D.J.C.); Oregon Health and Science University, Portland, OR (W.M.C.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Vascular Specialty Center, Baton Rouge, LA (A.D.S.); Ochsner Health System, New Orleans, LA (W.C.S.); the University of Southern California, Los Angeles, CA (F.A.W.); Columbia University, New York, NY (W.A.G..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"III","given":"W. Charles","family":"Sternbergh","sequence":"additional","affiliation":[{"name":"From the Saint Luke's Mid America Heart Institute, Kansas City, MO (K.R.V., E.A.M., H.L., D.J.C.); University of Missouri, Kansas City, MO (E.A.M., D.J.C.); Oregon Health and Science University, Portland, OR (W.M.C.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Vascular Specialty Center, Baton Rouge, LA (A.D.S.); Ochsner Health System, New Orleans, LA (W.C.S.); the University of Southern California, Los Angeles, CA (F.A.W.); Columbia University, New York, NY (W.A.G..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fred A.","family":"Weaver","sequence":"additional","affiliation":[{"name":"From the Saint Luke's Mid America Heart Institute, Kansas City, MO (K.R.V., E.A.M., H.L., D.J.C.); University of Missouri, Kansas City, MO (E.A.M., D.J.C.); Oregon Health and Science University, Portland, OR (W.M.C.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Vascular Specialty Center, Baton Rouge, LA (A.D.S.); Ochsner Health System, New Orleans, LA (W.C.S.); the University of Southern California, Los Angeles, CA (F.A.W.); Columbia University, New York, NY (W.A.G..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William A.","family":"Gray","sequence":"additional","affiliation":[{"name":"From the Saint Luke's Mid America Heart Institute, Kansas City, MO (K.R.V., E.A.M., H.L., D.J.C.); University of Missouri, Kansas City, MO (E.A.M., D.J.C.); Oregon Health and Science University, Portland, OR (W.M.C.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Vascular Specialty Center, Baton Rouge, LA (A.D.S.); Ochsner Health System, New Orleans, LA (W.C.S.); the University of Southern California, Los Angeles, CA (F.A.W.); Columbia University, New York, NY (W.A.G..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenifer H.","family":"Voeks","sequence":"additional","affiliation":[{"name":"From the Saint Luke's Mid America Heart Institute, Kansas City, MO (K.R.V., E.A.M., H.L., D.J.C.); University of Missouri, Kansas City, MO (E.A.M., D.J.C.); Oregon Health and Science University, Portland, OR (W.M.C.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Vascular Specialty Center, Baton Rouge, LA (A.D.S.); Ochsner Health System, New Orleans, LA (W.C.S.); the University of Southern California, Los Angeles, CA (F.A.W.); Columbia University, New York, NY (W.A.G..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas G.","family":"Brott","sequence":"additional","affiliation":[{"name":"From the Saint Luke's Mid America Heart Institute, Kansas City, MO (K.R.V., E.A.M., H.L., D.J.C.); University of Missouri, Kansas City, MO (E.A.M., D.J.C.); Oregon Health and Science University, Portland, OR (W.M.C.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Vascular Specialty Center, Baton Rouge, LA (A.D.S.); Ochsner Health System, New Orleans, LA (W.C.S.); the University of Southern California, Los Angeles, CA (F.A.W.); Columbia University, New York, NY (W.A.G..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Cohen","sequence":"additional","affiliation":[{"name":"From the Saint Luke's Mid America Heart Institute, Kansas City, MO (K.R.V., E.A.M., H.L., D.J.C.); University of Missouri, Kansas City, MO (E.A.M., D.J.C.); Oregon Health and Science University, Portland, OR (W.M.C.); Heritage Valley Health System, Heart and Vascular Center, Beaver, PA (R.J.B.); Vascular Specialty Center, Baton Rouge, LA (A.D.S.); Ochsner Health System, New Orleans, LA (W.C.S.); the University of Southern California, Los Angeles, CA (F.A.W.); Columbia University, New York, NY (W.A.G..."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4733.2004.75013.x"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1996.00440150083009"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.29.4.793"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1159\/000096542"},{"key":"e_1_3_3_6_2","first-page":"861","article-title":"Utilization of acute care services in the year before and after first stroke: a population-based study","volume":"46","author":"Leibson CL","year":"1996","unstructured":"Leibson CL, Hu T, Brown RD, Hass SL, O'Fallon WM, Whisnant JP. 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