Cost-Effectiveness Analysis of Percutaneous Patent Foramen Ovale Closure Preventing Secondary Ischemic Stroke in Japan |
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| Authors: | Sachie Inoue Ataru Igarashi Yasuyuki Iguchi Teiji Akagi |
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| Affiliation: | 2. Unit of Public Health and Preventive Medicine, Yokohama City University School of Medicine, Kanagawa, Japan;3. Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan;4. Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan;1. Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal;2. Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal;2. Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, United States;3. Department of Radiology, Rush University Medical Center, Chicago, Illinois, United States;4. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, United States;2. Department of Neurosurgery, Hakodate Municipal Hospital, Hakodate, Japan;1. Department of Hypertension and Nephrology (retired), Mayo Clinic, Jacksonville, FL, United States;2. Department of Interventional Cardiology, White Oak Medical Center, Silver Springs, MD, United States;3. Department of Vascular Surgery, Ochsner Health System, New Orleans, LA, United States;4. Department of Neurology, Medical University of South Carolina, Charleston, SC, United States;5. Department of Neurology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, United States;2. Division of Neurosurgery, University Surgical Cluster, National University Health System, Singapore |
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| Abstract: | ObjectivesPatent foramen ovale is a hemodynamically insignificant interatrial communication that may cause ischemic stroke. Percutaneous patent foramen ovale closure reduces the risk for recurrent ischemic stroke in patients with a history of cryptogenic ischemic stroke. This study evaluated the cost-effectiveness of patent foramen ovale closure against medical therapy in patients after their first cryptogenic ischemic stroke in Japan.Materials and methodsThe cost-effectiveness of patent foramen ovale closure compared with medical therapy was evaluated using the Markov model. The target patients started with patent foramen ovale closure or medical therapy for preventing secondary ischemic stroke under a stable state. Quality-adjusted life year was used as the outcome of effectiveness, and the analysis was conducted with a discount rate of 2% applied to both cost and effectiveness. The results of a multicenter open-label randomized controlled trial (RESPECT trial) evaluating patent foramen ovale closure using the Amplatzer? PFO Occluder were used as clinical evidence. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio. It was evaluated as cost-effective if it was lower than 5 million JPY/ quality-adjusted life year.ResultsPatent foramen ovale closure was dominant over medical therapy by 2.53 quality-adjusted life years and an estimated cost reduction of 2,353,926 JPY. The probability of patent foramen ovale closure being dominant was 82.9%.ConclusionsPatent foramen ovale closure was dominant over medical therapy for preventing secondary ischemic stroke in patients with cryptogenic ischemic stroke. |
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