David L Tirschwell1, Mark Turner2, David Thaler3, James Choulerton4, David Marks5, John Carroll6, Lee MacDonald7, Richard W Smalling8, Maria Koullick9, Ning Yan Gu9, Jeffrey L Saver10. 1. a UW Medicine Stroke Center , Harborview Medical Center , Seattle , WA , USA. 2. b Bristol Heart Institute , University Hospitals Bristol , Bristol , UK. 3. c Tufts Medical Center , Boston , MA , USA. 4. d Royal United Hospital , Bath , UK. 5. e Medical College of Wisconsin , Milwaukee , WI , USA. 6. f University of Colorado School of Medicine , Aurora , CO , USA. 7. g South Denver Cardiology Associates, P.C. , Littleton , CO , USA. 8. h UT Health/McGovern Medical School, Memorial Hermann Heart and Vascular Institute , Houston , TX , USA. 9. i Abbott , Abbott Park , IL , USA. 10. j Reed Neurologic Research Center , Los Angeles , CA , USA.
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.
RCT Entities:
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 strokepatients 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.
Authors: Jan B Pietzsch; Benjamin P Geisler; Matthew J Daniels; Rachele M Busca; Giuseppe Tarantini; Lars Søndergaard; Scott E Kasner Journal: Eur Stroke J Date: 2020-09-24
Authors: Lan Gao; Andrew Bivard; Mark Parsons; Neil J Spratt; Christopher Levi; Kenneth Butcher; Timothy Kleinig; Bernard Yan; Qiang Dong; Xin Cheng; Min Lou; Congguo Yin; Chushuang Chen; Peng Wang; Longting Lin; Philip Choi; Ferdinand Miteff; Marj Moodie Journal: Front Neurol Date: 2021-12-14 Impact factor: 4.003