Abstract

ARIAS, Aníbal M. et al. Cost-Effectiveness Analysis of Alternative Strategies for the Management of Patients with Cryptogenic Stroke and Patent Foramen OvaleCost-Effectiveness Analysis of Alternative Strategies for the Management of Patients with Cryptogenic Stroke and Patent Foramen Ovale. Rev. argent. cardiol. [online]. 2011, vol.79, n.4, pp.337-343. ISSN 1850-3748.

Background Patent foramen ovale (PFO) has been associated with cryp-togenic 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.

Keywords : Patent foramen oval; Cryptogenic stroke; Therapeutics; Economic evaluation; Cost-utility; Model.

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