Cost-effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke.
<h4>Background</h4>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 ov...
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Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0268690&type=printable |
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| author | Yoko Shijoh Shota Saito Zhehao Dai Sachiko Ohde |
| author_facet | Yoko Shijoh Shota Saito Zhehao Dai Sachiko Ohde |
| author_sort | Yoko Shijoh |
| collection | DOAJ |
| description | <h4>Background</h4>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 patients with patent foramen ovale related to cryptogenic strokes.<h4>Methods</h4>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. 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. The model was discounted at 2.0% and its cycle was one month. A willingness-to-pay threshold is set at $50,000 / quality-adjusted life years (QALYs). Incremental cost-effectiveness ratio was evaluated. Then one-way sensitivity analyses as deterministic sensitivity analysis, and probabilistic sensitivity analyses were performed to assess data robustness.<h4>Results</h4>Incremental quality-adjusted life years, incremental costs, and incremental cost-effectiveness ratio were 0.464, $13,562, and $29,208 per QALY gained, respectively. 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.<h4>Conclusions</h4>Patent foramen ovale closure was cost-effective compared with medical therapy for Japanese patients with cryptogenic stroke who were ≤60 years. |
| format | Article |
| id | doaj-art-418106b6528342ccade55982f22bc083 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-418106b6528342ccade55982f22bc0832025-08-20T03:01:59ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01176e026869010.1371/journal.pone.0268690Cost-effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke.Yoko ShijohShota SaitoZhehao DaiSachiko Ohde<h4>Background</h4>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 patients with patent foramen ovale related to cryptogenic strokes.<h4>Methods</h4>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. 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. The model was discounted at 2.0% and its cycle was one month. A willingness-to-pay threshold is set at $50,000 / quality-adjusted life years (QALYs). Incremental cost-effectiveness ratio was evaluated. Then one-way sensitivity analyses as deterministic sensitivity analysis, and probabilistic sensitivity analyses were performed to assess data robustness.<h4>Results</h4>Incremental quality-adjusted life years, incremental costs, and incremental cost-effectiveness ratio were 0.464, $13,562, and $29,208 per QALY gained, respectively. 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.<h4>Conclusions</h4>Patent foramen ovale closure was cost-effective compared with medical therapy for Japanese patients with cryptogenic stroke who were ≤60 years.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0268690&type=printable |
| spellingShingle | Yoko Shijoh Shota Saito Zhehao Dai Sachiko Ohde Cost-effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke. PLoS ONE |
| title | Cost-effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke. |
| title_full | Cost-effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke. |
| title_fullStr | Cost-effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke. |
| title_full_unstemmed | Cost-effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke. |
| title_short | Cost-effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke. |
| title_sort | cost effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0268690&type=printable |
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