Medicare Cost Comparison of Transcarotid Artery Revascularization (TCAR) Versus Transfemoral Carotid Artery Stenting (TF-CAS)
Author(s)
Sumaira Macdonald, MD, PhD, Alysha M. McGovern, MBA, Harshini Mashruwala, MS, Alexander Au-Yeung, MPH, Abimbola O. Williams, MPH, MS;
Boston Scientific, Marlborough, MA, USA
Boston Scientific, Marlborough, MA, USA
Presentation Documents
OBJECTIVES: Carotid artery disease (CAD) is a significant cause of morbidity and mortality worldwide, posing a substantial burden on healthcare systems. Two revascularization procedures, transcarotid artery revascularization (TCAR) and transfemoral carotid artery stenting (TF-CAS), are commonly used to manage carotid artery stenosis and reduce the risk of stroke in affected patients. However, their costs remain an important consideration. This study compared the Medicare costs for TCAR versus TF-CAS among patients with CAD.
METHODS: A retrospective claims-based analysis was conducted using the Medicare 100% Standard Analytical Files. Patients aged 65+ with CAD and a healthcare encounter for either TCAR or TF-CAS between 01/01/2022 and 12/31/2023, with at least 3 months of continuous Medicare Fee-for-Service enrollment pre-procedure, were included. Costs were defined as the Medicare amount paid for all medical services associated with the TCAR or TF-CAS admission, inflation-adjusted to 2023. Mean costs were compared using unpaired t-tests, while median costs were assessed using Wilcoxon-Mann-Whitney tests.
RESULTS: Among 8,255 TCAR and 17,067 TF-CAS patients (mean age 75.4 years; 91.4% White; 62.5% male, mean Charlson Comorbidity Index score 2.79 ), TCAR was associated with statistically significantly lower per-patient encounter-level mean ($16,898 ± $8,265 vs. $18,252 ± $11,388, p<0.0001) and median medical costs ($14,644 [interquartile range (IQR): $12,643-$18,235] vs. $15,307 [IQR: $12,547-$21,051], p<0.001) compared to TF-CAS. When stratified by year, TCAR consistently demonstrated lower costs than TF-CAS in 2022 (mean: $16,964 vs. $18,308, p<0.0001; median: $14,532 vs. $15,180, p<0.0001) and 2023 (mean: $16,854 vs. $18,198, p<0.0001; median: $14,745 vs. $15,485, p<0.0001).
CONCLUSIONS: TCAR demonstrates significant cost savings to Medicare compared to TF-CAS in the treatment of CAD. Broader adoption of TCAR could offer hospitals and payers an opportunity to reduce healthcare expenditures while maintaining positive patient outcomes. Understanding these economic implications is essential for guiding evidence-based clinical decisions and improving cost-effectiveness in patient care.
METHODS: A retrospective claims-based analysis was conducted using the Medicare 100% Standard Analytical Files. Patients aged 65+ with CAD and a healthcare encounter for either TCAR or TF-CAS between 01/01/2022 and 12/31/2023, with at least 3 months of continuous Medicare Fee-for-Service enrollment pre-procedure, were included. Costs were defined as the Medicare amount paid for all medical services associated with the TCAR or TF-CAS admission, inflation-adjusted to 2023. Mean costs were compared using unpaired t-tests, while median costs were assessed using Wilcoxon-Mann-Whitney tests.
RESULTS: Among 8,255 TCAR and 17,067 TF-CAS patients (mean age 75.4 years; 91.4% White; 62.5% male, mean Charlson Comorbidity Index score 2.79 ), TCAR was associated with statistically significantly lower per-patient encounter-level mean ($16,898 ± $8,265 vs. $18,252 ± $11,388, p<0.0001) and median medical costs ($14,644 [interquartile range (IQR): $12,643-$18,235] vs. $15,307 [IQR: $12,547-$21,051], p<0.001) compared to TF-CAS. When stratified by year, TCAR consistently demonstrated lower costs than TF-CAS in 2022 (mean: $16,964 vs. $18,308, p<0.0001; median: $14,532 vs. $15,180, p<0.0001) and 2023 (mean: $16,854 vs. $18,198, p<0.0001; median: $14,745 vs. $15,485, p<0.0001).
CONCLUSIONS: TCAR demonstrates significant cost savings to Medicare compared to TF-CAS in the treatment of CAD. Broader adoption of TCAR could offer hospitals and payers an opportunity to reduce healthcare expenditures while maintaining positive patient outcomes. Understanding these economic implications is essential for guiding evidence-based clinical decisions and improving cost-effectiveness in patient care.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE430
Topic
Economic Evaluation
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)