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Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
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Cost-effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke

Yoko Shijoh1, Shota Saito2, Zhehao Dai3,4

  • 1Graduate School of Public Health St. Luke's International University, Chuo-City, Tokyo, Japan.

Plos One
|June 3, 2022
PubMed

Insights

Patent foramen ovale closure is a cost-effective treatment for cryptogenic stroke in young Japanese patients. This intervention offers a favorable incremental cost-effectiveness ratio compared to medical therapy alone.

Area of Science:

  • Cardiovascular Medicine
  • Health Economics
  • Neurology

Background:

  • Patent foramen ovale closure reduces recurrent stroke risk in young patients with cryptogenic strokes.
  • Previous cost-effectiveness analyses outside Japan suggest PFO closure is cost-effective.
  • No studies have evaluated the cost-effectiveness of PFO closure in Japan.

Purpose of the Study:

  • To assess the cost-effectiveness of patent foramen ovale (PFO) closure versus medical therapy alone for Japanese patients with cryptogenic strokes.
  • To evaluate the economic impact from a Japanese healthcare payer's perspective.
  • To determine if PFO closure is a viable treatment option within Japan's healthcare system.

Main Methods:

  • A cost-effectiveness study using a decision tree and Markov model.
  • Utilized data from the RESPECT study for probabilities and a 5.9-year time horizon.
  • Assessed costs and utilities from published studies and expert opinions, with a willingness-to-pay threshold of $50,000/QALY.

Main Results:

  • The incremental cost-effectiveness ratio (ICER) was $29,208 per quality-adjusted life year (QALY) gained.
  • Patent foramen ovale closure was found to be cost-effective at a stable state utility score difference >0.051.
  • Probabilistic sensitivity analyses indicated a 50.3% probability of PFO closure being cost-effective.

Conclusions:

  • Patent foramen ovale closure is a cost-effective strategy compared to medical therapy alone for Japanese patients.
  • The study population included patients with cryptogenic stroke and PFO, aged 60 years or younger.
  • Findings support the consideration of PFO closure for eligible patients in Japan.
Abstract

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