학술논문
Cost-effectiveness of percutaneous patent foramen ovale closure as secondary stroke prevention.
Document Type
Academic Journal
Author
Tirschwell DL; a UW Medicine Stroke Center , Harborview Medical Center , Seattle , WA , USA.; Turner M; b Bristol Heart Institute , University Hospitals Bristol , Bristol , UK.; Thaler D; c Tufts Medical Center , Boston , MA , USA.; Choulerton J; d Royal United Hospital , Bath , UK.; Marks D; e Medical College of Wisconsin , Milwaukee , WI , USA.; Carroll J; f University of Colorado School of Medicine , Aurora , CO , USA.; MacDonald L; g South Denver Cardiology Associates, P.C. , Littleton , CO , USA.; Smalling RW; h UT Health/McGovern Medical School, Memorial Hermann Heart and Vascular Institute , Houston , TX , USA.; Koullick M; i Abbott , Abbott Park , IL , USA.; Gu NY; i Abbott , Abbott Park , IL , USA.; Saver JL; j Reed Neurologic Research Center , Los Angeles , CA , USA.
Source
Publisher: Taylor & Francis Country of Publication: England NLM ID: 9892255 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1941-837X (Electronic) Linking ISSN: 13696998 NLM ISO Abbreviation: J Med Econ Subsets: MEDLINE
Subject
Language
English
Abstract
Objective: Compared to medical therapy alone, percutaneous closure of patent foramen ovale (PFO) further reduces risk of recurrent ischemic strokes in carefully selected young to middle-aged patients with a recent cryptogenic ischemic stroke. The objective of this study was to evaluate the cost-effectiveness of this therapy in the context of the United Kingdom (UK) healthcare system.
Methods: A Markov cohort model consisting of four health states (Stable after index stroke, Post-Minor Recurrent Stroke, Post-Moderate Recurrent Stroke, and Death) was developed to simulate the economic outcomes of device-based PFO closure compared to medical therapy. Recurrent stroke event rates were extracted from a randomized clinical trial (RESPECT) with a median of 5.9-year follow-up. Health utilities and costs were obtained from published sources. One-way and probabilistic sensitivity analyses (PSA) were performed to assess robustness. The model was discounted at 3.5% and reported in 2016 Pounds Sterling.
Results: Compared with medical therapy alone and using a willingness-to-pay (WTP) threshold of £20,000, PFO closure reached cost-effectiveness at 4.2 years. Cost-effectiveness ratios (ICERs) at 4, 10, and 20 years were ₤20,951, ₤6,887, and ₤2,158, respectively. PFO closure was cost-effective for 89% of PSA iterations at year 10. Sensitivity analyses showed that the model was robust.
Conclusions: Considering the UK healthcare system perspective, percutaneous PFO closure in cryptogenic ischemic stroke patients is a cost-effective stroke prevention strategy compared to medical therapy alone. Its cost-effectiveness was driven by substantial reduction in recurrent strokes and patients' improved health-related quality-of-life.
Methods: A Markov cohort model consisting of four health states (Stable after index stroke, Post-Minor Recurrent Stroke, Post-Moderate Recurrent Stroke, and Death) was developed to simulate the economic outcomes of device-based PFO closure compared to medical therapy. Recurrent stroke event rates were extracted from a randomized clinical trial (RESPECT) with a median of 5.9-year follow-up. Health utilities and costs were obtained from published sources. One-way and probabilistic sensitivity analyses (PSA) were performed to assess robustness. The model was discounted at 3.5% and reported in 2016 Pounds Sterling.
Results: Compared with medical therapy alone and using a willingness-to-pay (WTP) threshold of £20,000, PFO closure reached cost-effectiveness at 4.2 years. Cost-effectiveness ratios (ICERs) at 4, 10, and 20 years were ₤20,951, ₤6,887, and ₤2,158, respectively. PFO closure was cost-effective for 89% of PSA iterations at year 10. Sensitivity analyses showed that the model was robust.
Conclusions: Considering the UK healthcare system perspective, percutaneous PFO closure in cryptogenic ischemic stroke patients is a cost-effective stroke prevention strategy compared to medical therapy alone. Its cost-effectiveness was driven by substantial reduction in recurrent strokes and patients' improved health-related quality-of-life.