Cost-Effectiveness Analysis of Alternative Strategies for the Management of Patients with Cryptogenic Stroke and Patent Foramen Ovale

Anibal Arias, Walter M. Masson, Ignacio M. Bluro, Pablo F. Oberti, Mariano L. Falconi, Rodolfo Pizarro, Juan G. Krauss, Arturo M. Cagide

Abstract


Background

Patent foramen ovale (PFO) has been associated with cryptogenic

stroke (CS). There are still some controversies about

the best treatment to prevent recurrences in patients with

CS and PFO. Our region lacks cost-utility analysis of the

management of these patients.

Objectives

To construct a decision model for the management of patients

with CS and PFO and to establish the cost-utility ratio of

three alternative strategies.

Material and Methods

We conducted a cost-utility analysis based on a decision tree

with a time horizon of 4 years considering three strategies:

aspirin (ASA), anticoagulants (AC) or percutaneous device

closure of the PFO. The benefits were expressed in QALYs.

A payment threshold of ARS $28,000 was established and a

sensitivity analysis was performed.

Results

Anticoagulants were more expensive compared to ASA (additional

cost of ARS $1,315) and produced less benefits (incremental

(QALY –0.063). Percutaneous device closure had an

additional cost of ARS $89,876 per QALY gained compared to

ASA. This cost exceeds the predetermined payment threshold.

After performing the sensitivity analysis, ASA remained as

the strategy with the best cost-utility ratio; however, when

the probability of recurrences with this drug increases to

35%, anticoagulants present an incremental cost-utility ratio

of ARS $1.356/QALY.

Conclusion

According to this model, in patients with CS and PFO, ASA

would be the strategy with the best cost-utility ratio in our

environment unless recurrences develop; in this case the use

of anticoagulants would be more appropriate.


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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar