We compared medical expenditure, length of hospital day, complications and intensity of clinical services during hospitalization for carotid endarterectomy (CEA) before, during and after the 2003 implementation of DPC-based PPS, which pays a fixed fee per discharge diagnosis. The medical expenditure during hospitalization for CEA was generally higher under DPC-based PPS, though the difference was only about 10%. The length of hospital day, sorts and number of examinations affected the costs somewhat, but there were no remarkable differences within ordinary perioperative course or with routine examinations. The situation should change with the spread and the revision of DPC-based PPS and medico-economic aspects may come to weigh much in the choice of examinations and treatments for carotid stenosis.