İzzet AYDEMİR, Afsun Ezel ESATOĞLU, İhsan DOĞAN

KAROTİS ENDARTEREKTOMİ VE KAROTİS ARTER STENTLEME YÖNTEMLERİNİN ÖDEYİCİ PERSPEKTİFİNDEN MALİYET-ETKİLİLİĞİNİN DEĞERLENDİRİLMESİ

Araştırmada karotis arter stenozu hastalığı (KrAH) tedavisinde karotis arter stentleme (KAS) ve karotis endarterektomi (KAE) yöntemlerinin maliyet etkililiğinin değerlendirilmesi amaçlanmıştır. Retrospektif ve kesitsel nitelikte olan bu araştırma, Ankara Üniversitesi İbni-Sina Hastanesi’nde 2019-2021 tarihleri arasında KrAH tanısı alan, KAS ve KAE yöntemleri ile tedavi olan 61 hastanın maliyet verileri analiz edilmiş ve hastalara EQ-5D-5L yaşam kalitesi ölçeği telefon ile uygulanmıştır. Hizmet başı ödeme kapsamında geri ödeme kurumu perspektifinden KAS ile tedavi olmanın ortalama hasta başına maliyeti 9.328,67₺, QALYs değeri ise 0,7974 birim; KAE ile tedavi olmanın ortalama hasta başına maliyeti 6.484,13₺, QALYs değeri ise 0,7887 birim olarak tespit edilmiştir. Araştırmada VAS skorları KAS yönteminde yaklaşık 0,79; KAE yönteminde ise 0,83 olarak bulunmuştur. Analiz sonucu İMEO değeri, kazanılan QALYs başına 326.958,62₺ olarak hesaplanmıştır. İMEO, maliyet etkililik düzleminde maliyet etkililik eşiğinin üstünde yer almıştır. Yıllık KrAH prevalansının %1,5 varsayımı altında KAS yönteminin bütçeye etkisi %4,51, KAE yönteminin bütçeye etkisi ise %3,14 olarak gerçekleşmiştir. Araştırmanın maliyet etkililik analizinde KAE yöntemi KAS yöntemine göre daha maliyet etkili olmuştur. Benzer endikasyonlara sahip olmak koşulu ile ödeyici kurum perspektifinden daha maliyet etkili olan KAE yönteminin tedavide uygulanması önerilmektedir.

Anahtar Kelimeler:

İMEO, karotis arter stenozu hastalığı, karotis arter stentleme, karotis endarterektomi, maliyet etkililik

ASSESSMENT OF COST-EFFECTIVENESS OF CAROTID ENDARTERECTOMY AND CAROTID ARTERY STENTING FROM PAYER PERSPECTIVE

The aim of this research is to evaluate the clinical and cost effectiveness of carotid artery stenting (CAS) and carotid endarterectomy (CAE) procedures in the treatment of carotid artery stenosis disease. In this retrospective and cross-sectional research, the cost data of 61 patients diagnosed with carotid artery stenosis disease and treated with CAS and CAE procedures at Ankara University İbni-Sina Hospital between 2019-2021 were analyzed and the EQ-5D-5L quality of life scale was applied to the patients by telephone. From the perspective of the reimbursement institution within the scope of fee for service payment, the average cost per patient being treated with CAS is 9.328.67₺, and the QALYs value is 0.7974 units; the average cost per patient being treated with CAE was 6,484.13₺, and the QALYs value was 0.7887 units. VAS scores were detected approximately 0,79 in the CAS procedure, and about 0,83 in CAE procedure. As a result of the analysis, the ICER value was calculated as 326,958.62₺ per QALYs gained. In the cost-effectiveness plane, ICER was located whereon the recommended cost-effectiveness threshold. Under the assumption of 1.5% annual prevalence of carotid artery stenosis disease, the effect of the CAS procedure on the budget was 4.51%, and the effect of the CAE procedure on the budget was about 3.14% respectively. As a result, it was observed that the CAS procedure could not achieve the desired success against CAE, due to its high costs. With similar indications, it is recommended that the CAE procedure, which is more cost effective from the perspective of the payers should be applied in treatment of carotid artery stenosis disease.

Keywords:

ICER, carotid artery stenosis disease, carotid artery stenting, carotid endarterectomy, cost-effectiveness,

PDF

___

Almekhlafi, M. A., Hill, M. D., Wiebe, S., Goyal, M., Yavin, D., Wong, J. H., & Clement, F. M. (2014). When is carotid angioplasty and stenting the cost-effective alternative for revascularization of symptomatic carotid stenosis? A Canadian health system perspective. American Journal of Neuroradiology, 35(2), 327-332.
Black, W. C. (1990). The CE plane: a graphic representation of cost-effectiveness. Medical decision making, 10(3), 212-214.
Çelik, Y. (2011). Sağlık Ekonomisi. Siyasal Kitabevi.
Drummond, M. F., Sculpher, M. J., Torrance, W. G., O’brien, B. J., & Stoddart, G. L. (2005). Methods for the economic evaluation of health care programmes (Third edition). Oxford Medical Publication.
European Network For Health Technology Assessment (EUnetHTA). (2016). HTA core model version 3.0 (pdf), Joint Action on HTA 2012-2015. (www.htacoremodel.info/BrowseModel.aspx.).
Featherstone, R. L., Dobson, J., Ederle, J., Doig, D., Bonati, L. H., Morris, S., Patel, N. V., & Brown, M. M. (2016). Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): a randomised controlled trial with cost-effectiveness analysis. Health technology assessment (Winchester, England), 20(20), 1-94.
Glick, H., Doshi, J., Sonnad, S. S., & Polsky, D. (2015). Economic evaluation in clinical trials. Oxford University Press.
Hamur, H., Değirmenci, H., Bakırcı, E. M., & Topal, E. (2016). Karotis arter hastalığının güncel girişimsel tedavisi. MN Kardiyoloji, 23(2), 147-157.
Hauck, K., Smith, P. C., & Goddard, M. (2004). The economics of priority setting for health care: A literature review. The World Bank.
Hopkins, R., & Goeree, R. (2015). Health technology assessment: Using Biostatistics to break the barriers of adopting new medicines. CRC Press.
Jiménez, S. V., Carrasco, P., Rodriguez, G., Doblas, M., Orgaz, A., Flores, A., Maynar, M., Gonzalez-Fajardo, J. A., & Fontcuberta, J. (2019). Cost-effectiveness of Carotid Surgery. Annals of vascular surgery, 57, 177-186.
Khan, A. A., Chaudhry, S. A., Sivagnanam, K., Hassan, A. E., Suri, M. F., & Qureshi, A. I. (2012). Cost-effectiveness of carotid artery stent placement versus endarterectomy in patients with carotid artery stenosis. Journal of Neurosurgery, 117(1), 89-93.
Kristensen, F. B., Husereau, D., Huić, M., Drummond, M., Berger, M. L., Bond, K., Augustovski, F., Booth, A., Bridges, J. F. P., Grimshaw, J., IJzerman, M. J., Jonsson, E., Ollendorf, D. A., Rüther, A., Siebert, U., Sharma, J., & Wailoo, A. (2019). Identifying the Need for Good Practices in Health Technology Assessment: Summary of the ISPOR HTA Council Working Group Report on Good Practices in HTA. Value in Health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research, 22(1), 13–20.
Kristensen, F. B., & Sigmund, H. (2008). Health technology assessment handbook, Danish centre for health technology assessment, national board of health. https://www.sst.dk/~/media/ECAAC5AA1D6943BEAC96907E03023E22.ashx.
Leelahavarong, P. (2014). Budget impact analysis. Journal of the Medical Association of Thailand, 97(5), 565-571.
Mahoney, E. M., Greenberg, D., Lavelle, T. A., Natarajan, A., Berezin, R., Ishak, K. J., Caro, J. J., Yadav, J. S., Gray, W. A., Wholey, M. H., & Cohen, D. J. (2011). Costs and cost-effectiveness of carotid stenting versus endarterectomy for patients at increased surgical risk: Results from the SAPPHIRE trial. Catheterization and Cardiovascular Interventions: Official Journal of the Society for Cardiac Angiography & Interventions, 77(4), 463–472.
Maud, A., Vázquez, G., Nyman, J. A., Lakshminarayan, K., Anderson, D. C., & Qureshi, A. I. (2010). Cost-effectiveness analysis of protected carotid artery stent placement versus endarterectomy in high-risk patients. Journal of Endovascular Therapy: An Official Journal of the International Society of Endovascular Specialists, 17(2), 224-229.
Mauskopf, J. A., Paul, J. E., Grant, D. M., & Stergachis, A. (2007). The role of cost-consequence analysis in healthcare decision-making. Pharmacoeconomics, 13(3), 277-288.
McPake, B., Normand, C., & Smith, S. (2013). Health economics an international perspective. Routledge Taylor and Francis Group.
Morris, S., Patel, N. V., Dobson, J., Featherstone, R. L., Richards, T., Luengo-Fernandez, R., Rothwell, P. M., Brown, M. M., & International Carotid Stenting Study investigators (2016). Cost-utility analysis of stenting versus endarterectomy in the International Carotid Stenting Study. International Journal of Stroke: Official Journal of the International Stroke Society, 11(4), 446-453.
Nuijten, M. J. C., & Dubois, D. J. (2011). Cost-utility analysis: Currrent methodological issues and future perspectives. Pharmaceutical Medicine and Outcomes Research, 2(29), 1-5.
Özgen, H., & Tatar, M. (2007). Sağlık sektöründe bir verimlilik değerlendirme tekniği olarak maliyet-etkililik analizi ve Türkiye'de durum. Hacettepe Sağlık İdaresi Dergisi, 10(2), 109-137.
Song, P., Fang, Z., Wang, H., Cai, Y., Rahimi, K., Zhu, Y., Fowkes, F. G. R,. Fowkes, F. J. L., & Rudan, I. (2020). Global and regional prevalence, burden, and risk factors for carotid atherosclerosis: A systematic review, meta-analysis, and modelling study. Lancet, 8, 721-729.
Sullivan, S.D., Mauskopf, J.A., Augustovski, F., Caro, J.J., Lee, K.M., Minchin, M., & Shau, W.Y. (2014). Budget impact analysis-principles of good practice: Report of the ISPOR 2012 budget impact analysis good practice II task force. Value in Health, 17(1), 5-14.
Tatar, M. (2017). İlaç fiyat ve geri ödeme politikalarında değer kavramı, polar sağlık ekonomisi ve politikası danışmanlık. www.polarsaglik.com.tr.
Tatar, M., & Wertheimer, A. I. (2010). Sağlık teknolojilerinin değerlendirilmesi-ilaç geri ödeme kararları için bir model önerisi. MN Medikal & Nobel Basım Yayın.
Türk Nöroşirürji Derneği (TND). (2020). Karotis arter hastalığı. https://www.turknorosirurji.org.tr/TNDData/Books/152/norovaskuler-cerrahi-ogretim-ve-egitim-grubu.pdf.
Uğurlu, M. (2017). Ülke deneyimleri ışığında sağlık teknoloji değerlendirmesinin sağlık finansman sisteminin sürdürülebilirliğine etkisi ve Türkiye için model önerisi [Doktora Tezi]. İstanbul Üniversitesi.
Vilain, K. R., Magnuson, E. A., Li, H., Clark, W. M., Begg, R. J., Sam, A. D., 2nd, Sternbergh, W. C., 3rd, Weaver, F. A., Gray, W. A., Voeks, J. H., Brott, T. G., Cohen, D. J., & CREST Investigators (2012). Costs and cost-effectiveness of carotid stenting versus endarterectomy for patients at standard surgical risk: results from the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST). Stroke, 43(9), 2408-2416.
Višnjić, A., Veličković, V., & Milosavljević, N. (2011). QALY-measure of cost‐benefit analysis of health interventions. Scientific Journal of the Faculty of Medicine, 28(4), 195-199
Young, K. C., Holloway, R. G., Burgin, W. S., & Benesch, C. G. (2010). A cost-effectiveness analysis of carotid artery stenting compared with endarterectomy. Journal of Stroke and Cerebrovascular Diseases, 19(5), 404-409.