Cost-effectiveness of percutaneous closure of a patent foramen ovale compared with medical management in patients with a cryptogenic stroke: from the US payer perspective

Volpi, John; Ridge, John R; Nakum, Mitesh; Rhodes, John F.; Søndergaard, Lars; Kasner, Scott E.

doi:10.1080/13696998.2019.1611587

Cited by 15 publications

(17 citation statements)

References 26 publications

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“…The analysis revealed that PFO closure is cost-effective in the base case model, resulting in an ICER of ¥3,318,152 per QALY gained. Previous costeffectiveness analyses outside Japan also revealed that PFO closure is cost-effective compared with medical therapy for cryptogenic stroke patients (11)(12)(13)(14)(15)(16). A cost-effectiveness study in the U.S. (11) showed that PFO closure achieved an ICER of $21,049 at five years.…”

Section: Discussionmentioning

confidence: 99%

“…Some cost-effectiveness analyses outside Japan have compared PFO closure and medical therapy alone for cryptogenic stroke patients and have shown that PFO closure is cost-effective for quality-adjusted life years (QALYs) gained. (11)(12)(13)(14)(15)(16). However, there have been no cost-effectiveness analyses in Japan and such analyses, which include cost information, utility scores, and a lifetable would be more convincing than cost-effectiveness analyses done outside Japan.…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke

Shijoh

Saito

Dai

et al. 2021

Preprint

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Background Closure of a patent foramen ovale reduces the risk of recurrent stroke compared with medical therapy alone in young patients with cryptogenic strokes revealed by randomized control trials. Some cost-effectiveness analyses outside Japan have shown that patent foramen ovale closure is cost-effective, but no studies have examined cost-effectiveness in Japan. The objective of this study is to assess cost-effectiveness, from the perspective of a Japanese healthcare payer, of patent foramen ovale closure versus medical therapy alone for the patients with patent foramen ovale related cryptogenic strokes. Methods A cost-effectiveness study was conducted by developing a decision tree and a Markov model. Probabilities and a 5.9-year time horizon followed the RESPECT study. Utilities and costs were based upon published studies and assumptions. The model cycle was one month. All assumptions were assessed by experts, including a cardiologist and a statistical expert. The target population comprised patients with cryptogenic stroke and patent foramen ovale, aged 60 years or younger. Incremental cost-effectiveness ratio was evaluated. Then one-way sensitivity analyses and probabilistic sensitivity analyses were conducted to assess robustness. Results Incremental cost-effectiveness ratio of patent foramen ovale closure compared with medical therapy was estimated at 3,318,152 yen per quality-adjusted life years gained. One-way sensitivity analysis showed that the stable state utility score difference between patent foramen ovale closure and medical therapy had the largest impact on incremental cost-effectiveness ratio. Patent foramen ovale closure is cost-effective at a stable state utility score difference of >0.051, compared with medical therapy. Probabilistic sensitivity analyses demonstrated that patent foramen ovale closure was 50.3% cost-effective with a willingness-to-pay threshold of 5,000,000 yen / quality-adjusted life years. Conclusions From a healthcare payer perspective, patent foramen ovale closure may be cost-effective compared with medical therapy for Japanese patients with cryptogenic stroke who were under 60 years.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke

Shijoh

Saito

Dai

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…Several studies have found that embolism caused by PFO is related to the size and shunt volume of PFO [29,30] . The larger the diameter of PFO, the greater the shunt volume, and the higher the probability of cerebral embolism [31] .…”

Section: Discussionmentioning

confidence: 99%

The research of the relationships between patent foramen ovale and ischemic stroke in elderly patients

Xiao-jian¹,

Jiang²,

Zhao³

et al. 2020

Preprint

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Background Research indicates that abnormal embolism caused by patent foramen ovale (PFO) may play an important role in cryptogenic stroke (CS). However, most researches has focused on young patients, and whether abnormal embolism caused by PFO also plays an important role in elderly CS is uncertain. The purpose of this study is to analyze the clinical characteristics of elderly patients with PFO, and to explore the correlation between elderly PFO and ischemic stroke.Methods 62 elderly patients diagnosed with ischemic stroke admitted to Qilu Hospital of Shandong University from April 2014 to April 2019 were selected as the Test Group. 62 non-stroke patients in our hospital's physical examination center and outpatient clinic were selected as the Control Group. Collect clinical data of patients for retrospective analysis.Results The incidence of PFO in the Test Group was significantly higher than that in the Control Group, the difference was statistically significant (p < 0.05). The proportion of large and medium shunt patients in the Test Group was significantly higher than that in the Control Group (p < 0.05). The proportion of patients with migraine in the PFO (+) group in the Test Group was significantly higher than the stroke patients in the PFO (-) group (p < 0.05).Conclusions The shunt volume of the PFO is related to ischemic stroke and may be a risk factor for ischemic stroke.

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“…In diesem Kontext erscheint auch eine Abwägung des Nettonutzens für den Patienten relevant: seltene, im Einzelfall aber schwere periprozedurale Komplikationen vs. Risikoreduktion von ischämischen Schlaganfällen mit regelhaft offenbar weniger schweren neurologischen Defiziten [3,9]. Dieser Aspekt sollte auch in Kosten-Nutzen-Analysen [25]…”

Section: Merkeunclassified

Verschluss des persistierenden Foramen ovale nach ischämischem Schlaganfall

Häusler¹,

Neugebauer²

2019

Dtsch med Wochenschr

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Secondary prevention of otherwise cryptogenic stroke in patients with patent foramen ovale (PFO) has been a matter of debate over nearly three decades. Main issues were that data essentially derived from case-control-studies for a long period and that results from the randomized controlled trials CLOSURE-I, PC Trial and RESPECT, which were published in 2012 and 2013, were interpreted in different ways. The likewise not blinded randomized controlled trials REDUCE, CLOSE and DEFENSE-PFO, which were published in 2017 and 2018, consistently demonstrated superiority of interventional PFO closure compared to secondary stroke prevention with antiplatelet therapy in patients 18 to 60 years with cryptogenic stroke and moderate to severe atrial right-to-left shunt. Consecutively, the German Society of Cardiology, the German Society of Neurology and the German Stroke Society published joint recommendations strongly recommending interventional PFO closure in these patients. This review article briefly summarizes current scientific knowledge. Furthermore, open questions regarding secondary prevention in otherwise cryptogenic stroke patients with PFO are discussed.

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Cost-effectiveness of percutaneous closure of a patent foramen ovale compared with medical management in patients with a cryptogenic stroke: from the US payer perspective

Cited by 15 publications

References 26 publications

Cost-effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke

Cost-effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke

The research of the relationships between patent foramen ovale and ischemic stroke in elderly patients

Verschluss des persistierenden Foramen ovale nach ischämischem Schlaganfall

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