| Tremendous progress continues in medicine due to technological innovation. However, long viewed as increasing health care costs, payors view it with an increasingly wary eye. This study compared a new technology, carotid stenting (CS), to surgical intervention, carotid endarterectomy (CE), for the treatment of carotid stenosis. This condition often leads to stroke, the third leading cause of death and the leading cause of disability in the U.S. Currently, carotid stenting is not routinely covered under the Medicare Program.; Cost-effectiveness analysis (CEA) was used to compare the two interventions. CEA is a methodology used for evaluating both the health outcomes and costs of health interventions. The primary measure of a CEA is the cost-effectiveness ratio. The numerator of the ratio consists of the incremental costs between the interventions and the denominator, the incremental effectiveness. Three CEAs compared a cohort of patients receiving a CS to the following cohorts of patients receiving CE: patients from the same hospital site, Medicare beneficiaries from a national sample of hospitals defined as proficient providers of the surgery, and a national, random sample of Medicare beneficiaries.; The CEAs demonstrated CS provided a cost-savings of {dollar}962–{dollar}2,929 per intervention from a payor perspective although slightly less effective, 0.10–0.20 QALY. The Medicare Program could provide full coverage for carotid stenting, continue to deny coverage until further studies unequivocally prove the carotid stent is a cost-effective alternative, or provide limited coverage. Based on this study's results and the current medical literature, the Medicare Program should cover CS on a restricted basis. Under this coverage policy, it is estimated that 15% of the 100,000 annual CEs performed would be replaced by carotid stents, with a weighted average payor cost savings of approximately {dollar}154 million with little loss of QALYs. However, it is estimated that 10,000–20,000 additional carotid stents would be performed, quickly leading to increased costs for the Medicare Program, often the paradox of new technology. Finally, the methodology of cost-effectiveness analysis can be used to inform policy-makers early in the diffusion process about the potential value of new technologies but should not be the only consideration for coverage. |
