To analyze the cost-effectiveness of carotid endarterectomy carotid endarterectomy (CEA) and medical therapy for asymptomatic carotid stenosis in Chinese patients over 70 years old.

Based on the data of different outcomes of asymptomatic carotid stenosis patients who were followed up by CEA and drug therapy for 10 years, a Markov model was established to simulate the cost-effectiveness of the two treatments for 10 years. The outcome index was incremental cost-effectiveness ratio (ICER), which was the ratio of increased cost to increased quality-adjusted life years (QALY), and the thresholds of ICER and willingness to pay (WTP) were compared. In this paper, scenario analysis was carried out, and uncertainty test was carried out by single factor sensitivity analysis and probability sensitivity analysis.

In the basic case analysis, the patients who received CEA could get 7.53 QALYs, the corresponding cost was 67 079.61 yuan and 31 982.38 yuan, and the ICER was 129 435.97 yuan / QALY, which was lower than the threshold of WTP. In scenario analysis, the ICER was 127 946.82 yuan / QALY and 240 283.17 yuan / QALY, respectively. The annual mortality of patients after CEA, the operation cost of CEA, and the perioperative mortality after CEA had great influence on the fluctuation of ICER.

According to the economic evaluation recommendation of WHO, the increased cost of CEA compared with drug therapy is acceptable for Chinese patients with asymptomatic carotid artery stenosis over 70 years old.