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PFO closure may be cost-effective in long term
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Percutaneous patent foramen ovale closure was more cost effective than medical therapy during the long term in a recent study published in the American Journal of Cardiology.
The researchers conducted a cost effectiveness analysis of PFO closure using outcome and complication rates from a number of sources, including randomized controlled trials, Medicare cost tables and wholesale drug prices. Outcomes included cost for each life year gained and each quality-adjusted life-year (QALY) gained by use of PFO closure. The cost-effectiveness threshold was defined as <$50,000 per QALY gained.
The mean duration of follow-up in the randomized trials was 2.6 years. At this point, it was determined that PFO closure cost $16,213 (95% CI, 15,753-16,749) per patient. The cost per life-year gained was $103,607 (95% CI, 5,826-2,544,750) at this time point.
Other results indicated a cost of $1.09 million (95% CI, 1.04 million-1.20 million) required to prevent one combined endpoint of transient ischemic attack, stroke or death at 2.6 years follow-up.
When the researchers prospectively modeled the cost of the intervention, PFO closure reached the endpoint of <$50,000 per QALY gained at 2.6 years (95% CI, 1.5-44.2).
The per-patient mean cost of medical therapy was greater than the cost of PFO closure by 30.2 years (95% CI, 28.2-36.2).
“PFO closure is associated with higher expenditures related to procedural costs; however, this increase may be offset over time by reduced event rates and costs of long-term medical treatment in patients who undergo transcatheter PFO closure,” the researchers concluded. “In younger patients typical of cryptogenic stroke, PFO closure may be cost effective in the long term.”
Disclosure: The researchers report no relevant financial disclosures.
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