Key result
Percutaneous PFO closure is cost-effective versus antiplatelet therapy alone at ~£18,600 per QALY.
Why the study?
Percutaneous PFO closure lowers recurrent stroke risk after cryptogenic stroke, but its economic implications from a UK payer perspective are less well known.
Is percutaneous closure of a PFO cost-effective compared to antiplatelet therapy alone in patients with a cryptogenic stroke?
Is percutaneous closure of a PFO cost-effective compared to antiplatelet therapy alone in patients with a cryptogenic stroke?
Percutaneous PFO closure is cost-effective compared with antiplatelet therapy alone for secondary stroke prevention in the UK healthcare setting.
May inform UK reimbursement for PFO closure post-cryptogenic stroke; leaves open need for longer-term real-world validation.
AIMS: Percutaneous closure of a patent foramen ovale (PFO) is known to lower the risk of recurrent stroke in patients with a cryptogenic stroke. However, the economic implications of transcatheter PFO closure are less well known. From a UK payer perspective, a detailed economic appraisal of PFO closure was performed for prevention of recurrent ischemic stroke in patients with a PFO who had experienced a cryptogenic stroke. MATERIALS AND METHODS: A Markov cohort model was constructed using a 5-year time-horizon with a patient mean age of 45.2 years, reflecting the characteristics reported in the REDUCE trial. Transition probabilities, clinical inputs, costs, and utility values were ascertained from published and national costing sources. Total costs, incremental costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios were calculated, utilizing a discount rate of 3.5%. A range of univariate and probabilistic sensitivity analyses were also performed. RESULTS: When applying a willingness-to-pay (WTP) threshold of £20,000/QALY in accordance with NICE guidelines, PFO closure compared with antiplatelet therapy alone showed a beneficial cost/QALY of £18,584, attained at 4 years. Applying discount rates of 0% and 6% had a negligible effect on the base-case model findings. PFO closure demonstrated a 76.9% probability of being cost-effective at a WTP threshold of £20,000/QALY at a 5-year time-horizon. LIMITATIONS: This model focused specifically on UK stroke patients and typically enrolled young (mean age <65 years old) patients. Hence, caution should be taken when comparing data vs non-UK populations, and it remains unclear how older patients might have affected cost-effectiveness findings, as the risk of paradoxical embolism can persist as patients age. CONCLUSION: Percutaneous closure of a PFO is cost-effective compared with antiplatelet therapy alone, underlining the economic benefits potentially afforded by this treatment in selected patients.
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Hildick‐Smith et al. (2018) studied Cryptogenic stroke with patent foramen ovale. Percutaneous closure of a patent foramen ovale vs. Antiplatelet therapy alone was evaluated on Incremental cost-effectiveness ratio (cost/QALY) (ICER £18,584/QALY). Percutaneous PFO closure was cost-effective compared with antiplatelet therapy alone, demonstrating an incremental cost-effectiveness ratio of £18,584 per QALY at 4 years.
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