Cost-effectiveness of outpatient cardiac monitoring to detect atrial fibrillation after ischemic stroke.

Abstract

BACKGROUND AND PURPOSE:

Extending the duration of continuous electrocardiography after ischemic stroke detects more new cases of atrial fibrillation, which is an important and treatable cause of stroke, but the cost-effectiveness of this approach is unknown. Therefore, we performed a cost-utility analysis of outpatient cardiac monitoring after ischemic stroke.

METHODS:

Using a Markov model, we determined the lifetime cost and utility of warfarin therapy in a hypothetical cohort of 70-year-old patients with atrial fibrillation, prior stroke, and no contraindication to warfarin therapy. Meta-analysis was used to determine the yield of outpatient cardiac monitoring.

RESULTS:

Outpatient cardiac monitoring would detect 44 new cases of atrial fibrillation for every 1000 patients monitored. This would result in a gain of 34 quality-adjusted life-years at a net cost of $440,000. Therefore, the cost-utility ratio of outpatient cardiac monitoring would be $13,000 per quality-adjusted life-years gained. Outpatient monitoring remained cost-effective throughout a wide range of model inputs in sensitivity analyses, including changes in the cost and yield of monitoring.

CONCLUSIONS:

By identifying patients with paroxysmal atrial fibrillation who will benefit from anticoagulation, outpatient cardiac monitoring is cost-effective after ischemic stroke over a wide range of model inputs. The optimal duration and method of monitoring is unknown.

• Authors: Hooman Kamel, Manu Hegde, Derek R Johnson, Brian F Gage, S Claiborne Johnston
• Journal: Stroke (Stroke) Vol. 41 Issue 7 Pg. 1514-20 (Jul 2010) ISSN: 1524-4628 [Electronic] United States
• PMID: 20508188 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Aged, 80 and over
• Atrial Fibrillation (diagnosis, economics, etiology, physiopathology)
• Brain Ischemia (complications, economics, physiopathology)
• Cost-Benefit Analysis (economics)
• Electrocardiography, Ambulatory (economics)
• Female
• Humans
• Male
• Monitoring, Ambulatory (economics)
• Quality-Adjusted Life Years
• Stroke (complications, economics, physiopathology)
• Treatment Outcome