Resource Efficiency of Carotid Endarterectomy: Comparison of Clinical Effect and Financial Costs

Carotid endarterectomy (CEA) remains the gold standard for surgical prevention of ischemic stroke in atherosclerotic carotid artery stenosis. However, its widespread use faces severe budgetary constraints. This paper presents a comparative analysis of the resource effectiveness of CEA and conservative medical therapy using a cost-utility analysis. Using a retrospective cohort analysis and Markov modeling, the incremental cost-effectiveness ratio (ICER) per additional quality-adjusted life year (QALY) gained is calculated. Particular attention is paid to differentiating economic outcomes depending on the severity of stenosis and the presence of preexisting neurological symptoms. The results demonstrate that for patients with symptomatic stenosis, CEA is an economically feasible intervention: preventing recurrent strokes and subsequent severe disability generates significant long-term savings for the healthcare system, outweighing the initial surgical and hospital costs. In the asymptomatic cohort, the cost-effectiveness of the procedure varies significantly and is directly dependent on the perioperative risk of complications and the cost of postoperative rehabilitation. The need for rigorous risk-stratified algorithms for selecting candidates for CEA is substantiated. This approach optimizes the allocation of limited resources in the compulsory health insurance system, minimizes wasteful spending, and improves the overall allocative efficiency of specialized vascular care.