Cost-effectiveness of percutaneous patent foramen ovale closure versus medical therapy for cryptogenic stroke prevention: A Chinese healthcare perspective.

PFO closure was economically dominant over medical therapy, providing more QALYs at lower cost.

• PFO closure yielded 13.42 QALYs compared to 12.01 QALYs for medical therapy, a difference of 1.41 additional QALYs.
• Lifetime costs were lower with PFO closure ($8,847) than with medical therapy ($12,892), a reduction of $4,045 per patient.
• The incremental cost-effectiveness ratio (ICER) was -$2,868 per QALY, indicating superior outcomes at lower cost.
• Results were evaluated against China's willingness-to-pay threshold of $37,654 per QALY.

Probabilistic sensitivity analysis showed a high probability of cost-effectiveness for PFO closure at the Chinese willingness-to-pay threshold.

• Probabilistic sensitivity analysis revealed a 94.2% probability of cost-effectiveness at the Chinese threshold of $37,654 per QALY.
• This analysis was conducted to examine parameter uncertainty and model robustness.

One-way sensitivity analyses consistently produced negative ICERs across all parameter ranges, supporting the robustness of the dominance finding.

• One-way sensitivity analyses showed negative ICERs across all parameter ranges tested.
• Time horizon and psychological comorbidity costs exerted the greatest influence on results among the parameters examined.

A Markov cohort model with a 30-year time horizon and Chinese-specific data was used to conduct the cost-effectiveness analysis.

• The model included four health states: stable, post-minor recurrent stroke, post-moderate-to-severe recurrent stroke, and death.
• Model cycles were 3 months in length over a 30-year time horizon.
• The analysis adopted a Chinese healthcare payer perspective.
• Transition probabilities were derived primarily from the RESPECT trial extended follow-up data.
• Cost data were obtained from multi-center hospital surveys to reflect Chinese-specific costs.

Patent foramen ovale occurs in approximately 25% of cryptogenic stroke patients, with paradoxical embolization as a key pathophysiological mechanism.

• The prevalence of PFO in cryptogenic stroke patients is reported as approximately 25%.
• Paradoxical embolization is identified as a key pathophysiological mechanism linking PFO to cryptogenic stroke.
• Recent trials have established the clinical efficacy of percutaneous PFO closure in reducing recurrent stroke risk.