To evaluate the cost-effectiveness of percutaneous patent foramen ovale (PFO) closure, from a US payer perspective. Lower rates of recurrent ischemic stroke have been documented following percutaneous PFO closure in properly selected patients. Stroke in patients aged <60 years is particularly interesting because this population is typically at peak economic productivity and vulnerable to prolonged disability. A Markov model comprising six health states (Stable after index stroke, Transient ischemic attack, Post-Transient Ischemic Attack, Clinical ischemic stroke, Post-clinical ischemic stroke, and Death) was constructed to evaluate the cost-effectiveness of PFO closure in combination with medical management versus medical management alone. The base-case model employed a 5-year time-horizon, with transition probabilities, clinical inputs, costs, and utility values ascertained from published and national costing sources. Incremental cost-effectiveness ratio (ICER) was evaluated per US guidelines, utilizing a discount rate of 3.0%. At 5 years, overall costs and quality-adjusted life-years (QALYs) obtained from PFO closure compared with medical management were $16,323 vs $7,670 and 4.18 vs 3.77, respectively. At 5 years, PFO closure achieved an ICER of $21,049, beneficially lower than the conventional threshold of $50,000. PFO closure reached cost-effectiveness at 2.3 years (ICER = $47,145). Applying discount rates of 0% and 6% had a negligible impact on base-case model findings. Furthermore, PFO closure was 95.4% likely to be cost-effective, with a willingness-to-pay (WTP) threshold of $50,000 and a 5-year time horizon. From a cost perspective, our economic model employed a US patient sub-population, so cost data may not extrapolate to other non-US stroke populations. Percutaneous PFO closure plus medical management represents a cost-effective approach for lowering the risk of recurrent stroke compared with medical management alone.
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http://dx.doi.org/10.1080/13696998.2019.1611587 | DOI Listing |
Med J Islam Repub Iran
September 2024
Department of Public Health, Asadabad School of Medical Sciences, Asadabad, Iran.
Background: One of the most important causes of mortality in the world is acute myocardial infarction. There are two general treatments including thrombolytic drugs and percutaneous coronary interventions. But, monitoring outpatient AMI treatment from a remote or rural location has emerged as a successful telemedicine technique.
View Article and Find Full Text PDFCatheter Cardiovasc Interv
January 2025
HartCentrum Ziekenhuis Aan de Stroom (ZAS) Middelheim, Antwerp, Belgium.
JVS Vasc Insights
January 2024
Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh.
Objective: The aim of this study was to review the most commonly used percutaneous mechanical thrombectomy devices for the treatment of pulmonary embolism today.
Methods: A thorough search of the existing literature was conducted on commonly used percutaneous mechanical thrombectomy devices, most notably Inari Flowtriever, Penumbra's Indigo Aspiration, and Alphavac. Reported qualitative and quantitative information was abstracted and descriptively reviewed to ascertain the clinical utility and effectiveness of these devices.
Am Heart J
December 2024
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
Background: Percutaneous coronary intervention of severely calcified lesions is limited by inadequate stent expansion and poor clinical outcomes. Over the past decade, several devices and techniques have been developed for calcium modification and lesion preparation. Intravascular lithotripsy (IVL) is a novel tool in this context.
View Article and Find Full Text PDFAm Heart J
December 2024
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Background: Concomitant coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The optimal treatment strategy for CAD is a topic of debate. An initial conservative strategy for CAD in patients undergoing TAVI may be favorable as multiple studies have failed to show an evident beneficial effect of percutaneous coronary intervention (PCI) on mortality after TAVI.
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