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Carotid artery stenosis classification, costs vary by institution
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Diagnostic criteria for carotid duplex ultrasonography results differ substantially between institutions in New England, leading to wide variability in the classification and costs related to carotid artery stenosis.
Researchers performed a retrospective review of 10,614 patients who underwent 15,534 carotid duplex scans of 31,025 arteries at the University of Massachusetts noninvasive vascular laboratories from 2008 to 2012. The cohort included 7,650 patients assessed for asymptomatic CAD and 2,964 assessed for symptomatic disease.
The diagnostic criteria used to interpret carotid duplex ultrasound results were collected from an additional 10 vascular laboratories at 10 other institutions throughout New England, including seven accredited by the Intersocietal Accreditation Commission (IAC). The number of carotid revascularizations that would occur at three potential treatment thresholds — 70% to 79%, asymptomatic; 80% to 99%, asymptomatic; 50% to 99%, symptomatic — was determined for each criteria. Potential costs for these procedures were determined according to the 2011 mean Medicare reimbursement for carotid endarterectomy ($11,802.21).
Wide variations were observed between the criteria for each of the evaluated thresholds. At the 70% to 99% intervention threshold for asymptomatic stenosis, the number of patients who would have been offered revascularization ranged from 186 to 2,201 of the asymptomatic patients. At the 80% to 99% asymptomatic threshold, this number ranged from 78 to 426 patients. At the 50% to 99% threshold for symptomatic stenosis, the number of patients who would have been offered revascularization ranged from 157 to 781 of symptomatic patients.
Across the 10 criteria, researchers calculated potential revascularization costs ranging from $2.2 million to $26 million for the 70% to 90% asymptomatic threshold; $0.9 million to $5 million for the 80% to 99% asymptomatic threshold; and $1.9 million to $9.2 million for the 50% to 99% symptomatic treatment threshold.
“This study demonstrates the significant variation in carotid duplex criteria used by 10 institutions with both accredited and nonaccredited vascular laboratories,” the researchers wrote. “The downstream effects of this variation on treatment and costs are significant. Standardization of carotid duplex ultrasound criteria is a long-standing substantial unmet need that will help to standardize the care of patients with carotid artery occlusive disease and may assist to control health care costs.”
Disclosure: The researchers report no relevant financial disclosures.
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