Cost-effectiveness of 7-day-Holter monitoring alone or in combination with transthoracic echocardiography in patients with cerebral ischemia
2013 | journal article. A publication with affiliation to the University of Göttingen.
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Cost-effectiveness of 7-day-Holter monitoring alone or in combination with transthoracic echocardiography in patients with cerebral ischemia
Mayer, F.; Stahrenberg, R.; Groeschel, K.; Mostardt, S.; Biermann, J.; Edelmann, F. T. & Liman, J. et al. (2013)
Clinical Research in Cardiology, 102(12) pp. 875-884. DOI: https://doi.org/10.1007/s00392-013-0601-2
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Details
- Authors
- Mayer, Felix; Stahrenberg, Raoul; Groeschel, Klaus; Mostardt, Sarah; Biermann, Janine; Edelmann, Frank T.; Liman, Jan ; Wasem, Juergen; Goehler, Alexander; Wachter, R. Rolf; Neumann, Anja
- Abstract
- Prolonged Holter monitoring of patients with cerebral ischemia increases the detection rate of paroxysmal atrial fibrillation (PAF); this leads to improved antithrombotic regimens aimed at preventing recurrent ischemic strokes. The aim of this study was to compare a 7-day-Holter monitoring (7-d-Holter) alone or in combination with prior selection via transthoracic echocardiography (TTE) to a standard 24-h-Holter using a cost-utility analysis. Lifetime cost, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICER) were estimated for a cohort of patients with acute cerebral ischemia and no contraindication to oral anticoagulation. A Markov model was developed to simulate the long-term course and progression of cerebral ischemia considering the different diagnostic algorithms (24-h-Holter, 7-d-Holter, 7-d-Holter after preselection by TTE). Clinical data for these algorithms were derived from the prospective observational Find-AF study (ISRCTN 46104198). Predicted lifelong discounted costs were 33,837 a,not sign for patients diagnosed by the 7-d-Holter and 33,852 a,not sign by the standard 24-h-Holter. Cumulated QALYs were 3.868 for the 7-d-Holter compared to 3.844 for the 24-h-Holter. The 7-d-Holter dominated the 24-h-Holter in the base-case scenario and remained cost-effective in extensive sensitivity analysis of key input parameter with a maximum of 8,354 a,not sign/QALY gained. Preselecting patients for the 7-d-Holter had no positive effect on the cost-effectiveness. A 7-d-Holter to detect PAF in patients with cerebral ischemia is cost-effective. It increases the detection which leads to improved antithrombotic regimens; therefore, it avoids recurrent strokes, saves future costs, and decreases quality of life impairment. Preselecting patients by TTE does not improve cost-effectiveness.
- Issue Date
- 2013
- Status
- published
- Publisher
- Springer
- Journal
- Clinical Research in Cardiology
- ISSN
- 1861-0692; 1861-0684
- Sponsor
- Medtronic