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Echocardiographic risk stratification for early surgery with endocarditis: a cost-effectiveness analysis
1Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA. liao0002@mc.duke.edu
Heart (British Cardiac Society)
|June 19, 2007
Summary
Echocardiography-guided risk stratification for infective endocarditis (IE) surgery is cost-effective, improving patient outcomes for an incremental cost under $50,000 per quality-adjusted life year (QALY). This strategy is particularly beneficial for patients with higher baseline stroke risks.
Area of Science:
- Cardiology
- Health Economics
- Medical Decision Making
Background:
- Echocardiography is widely used for diagnosing infective endocarditis (IE).
- Its role in risk stratification for therapeutic decisions remains under-evaluated.
Purpose of the Study:
- To assess the cost-effectiveness of an echocardiography-guided risk-stratification strategy for IE.
- To compare this strategy against standard care for surgical decision-making.
Main Methods:
- A decision tree and Markov analysis model were developed.
- Models utilized published and institutional data.
- Compared standard care (clinical factors) vs. echocardiography-guided surgery for high-risk IE patients.
Main Results:
- The echocardiography-guided strategy cost $53,669 per patient, yielding 6.10 QALYs.
- This represents an incremental cost of $23,867 per QALY gained compared to standard care.
- Cost-effectiveness was sensitive to baseline stroke risk, becoming dominant at >18.3% risk.
Conclusions:
- Echocardiography-guided risk stratification for early surgery in IE is cost-attractive.
- It improves outcomes for an incremental cost <$50,000/QALY, especially for patients with large vegetations.
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