IDEAS home Printed from https://ideas.repec.org/a/sae/medema/v27y2007i2p161-177.html
   My bibliography  Save this article

Cost-Effectiveness of Echocardiography to Identify Intracardiac Thrombus among Patients with First Stroke or Transient Ischemic Attack

Author

Listed:
  • Richard T. Meenan

    (Center for health Research,Portland, Richard.meenan@kpchr.org, Center for Health Research, Kaiser Permanente Northwest, Portland, OR, Section of General Internal Medicine, Portland VA Medical Center, Portland, OR)

  • Somnath Saha

    (Oregon Health & Science University, Portland, Center for Health Research, Kaiser Permanente Northwest, Portland, OR)

  • Roger Chou

    (Section of General Internal Medicine, Portland VA Medical Center, Portland, OR)

  • Karleen Swarztrauber

    (Department of Neurology, Oregon Health & Science University, Portland)

  • Kathryn Pyle Krages

    (Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR)

  • Maureen C. O'Keeffe-Rosetti

    (Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR)

  • Marian McDonagh

    (Center for Health Research, Kaiser Permanente Northwest, Portland, OR)

  • Benjamin K. S. Chan

    (Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR)

  • Mark C. Hornbrook

    (Center for Health Research, Kaiser Permanente Northwest, Portland, OR)

  • Mark Helfand

    (Section of General Internal Medicine, Portland VA Medical Center, Portland, OR)

Abstract

Background and Purpose . Echocardiography to select stroke patients for targeted treatments, such as anticoagulation (AC), to reduce recurrent stroke risk is controversial. The authors' objective was to evaluate the cost-effectiveness of imaging strategies that use transthoracic (TTE) and transesophageal (TEE) echocardiography for identifying intracardiac thrombus in new stroke patients. Methods . Model-based cost-effectiveness analysis of 7 echocardiographic imaging strategies and 2 nontesting strategies with model parameters based on systematic evidence review related to effectiveness of echocardiography in newly diagnosed ischemic stroke patients (white males aged 65 years in base case). Primary outcome was cost per quality-adjusted life year (QALY). Results . All strategies containing TTE were dominated by others and were eliminated from the analysis. Assuming that AC reduces recurrent stroke risk from intracardiac thrombus by 43% over 1 year, TEE generated a cost per QALY of $137,000 (relative to standard treatment) among patients with 5% thrombus prevalence. Cost per QALY dropped to $50,000 in patients with at least 15% intracardiac thrombus prevalence, or, if an 86% relative risk reduction with AC is assumed, in patients with thrombus prevalence of at least 6%. Probabilistic analyses indicate considerable uncertainty around the cost-effectiveness of echocardiography across a wide range of intracardiac thrombus prevalence (pretest probability). Conclusions . Current evidence on cost-effectiveness is insufficient to justify widespread use of echocardiography in stroke patients. Additional research on recurrent stroke risk in patients with intracardiac thrombus and on the efficacy of AC in reducing that risk may contribute to a better understanding of the circumstances under which echocardiography will be cost-effective. Key words: cost-effectiveness; decision analysis; stroke; transesophageal echocardiography; transthoracic echocardiography; diagnostic imaging. (Med Decis Making 2007;27:161—177)

Suggested Citation

  • Richard T. Meenan & Somnath Saha & Roger Chou & Karleen Swarztrauber & Kathryn Pyle Krages & Maureen C. O'Keeffe-Rosetti & Marian McDonagh & Benjamin K. S. Chan & Mark C. Hornbrook & Mark Helfand, 2007. "Cost-Effectiveness of Echocardiography to Identify Intracardiac Thrombus among Patients with First Stroke or Transient Ischemic Attack," Medical Decision Making, , vol. 27(2), pages 161-177, March.
    • Handle: RePEc:sae:medema:v:27:y:2007:i:2:p:161-177
    DOI: 10.1177/0272989X06297388
    as

    Download full text from publisher

    File URL: https://journals.sagepub.com/doi/10.1177/0272989X06297388
    Download Restriction: no
    File URL: https://libkey.io/10.1177/0272989X06297388?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Elisabeth Fenwick & Karl Claxton & Mark Sculpher, 2001. "Representing uncertainty: the role of cost‐effectiveness acceptability curves," Health Economics, John Wiley & Sons, Ltd., vol. 10(8), pages 779-787, December.
    2. Claxton, Karl, 1999. "The irrelevance of inference: a decision-making approach to the stochastic evaluation of health care technologies," Journal of Health Economics, Elsevier, vol. 18(3), pages 341-364, June.
    3. Garber, Alan M., 2000. "Advances in cost-effectiveness analysis of health interventions," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 4, pages 181-221, Elsevier.
    4. A. J. Culyer & J. P. Newhouse (ed.), 2000. "Handbook of Health Economics," Handbook of Health Economics, Elsevier, edition 1, volume 1, number 1.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Sharma, Rajiv & Stano, Miron, 2010. "Implications of an economic model of health states worse than dead," Journal of Health Economics, Elsevier, vol. 29(4), pages 536-540, July.
    2. Anna-Liesa Lange & Philipp Otto, 2016. "Bayes’sche Statistik in der Dienstleistungsforschung [Bayesian statistics in service research]," AStA Wirtschafts- und Sozialstatistisches Archiv, Springer;Deutsche Statistische Gesellschaft - German Statistical Society, vol. 10(4), pages 247-267, December.
    3. Benjamin O Yarnoff & Thomas J Hoerger & Siobhan A Simpson & Meda E Pavkov & Nilka R Burrows & Sundar S Shrestha & Desmond E Williams & Xiaohui Zhuo, 2016. "The Cost-Effectiveness of Anemia Treatment for Persons with Chronic Kidney Disease," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-14, July.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Michał Jakubczyk & Bogumił Kamiński, 2017. "Fuzzy approach to decision analysis with multiple criteria and uncertainty in health technology assessment," Annals of Operations Research, Springer, vol. 251(1), pages 301-324, April.
    2. McKenna, Claire & Chalabi, Zaid & Epstein, David & Claxton, Karl, 2010. "Budgetary policies and available actions: A generalisation of decision rules for allocation and research decisions," Journal of Health Economics, Elsevier, vol. 29(1), pages 170-181, January.
    3. Rachael L. Fleurence, 2007. "Setting priorities for research: a practical application of 'payback' and expected value of information," Health Economics, John Wiley & Sons, Ltd., vol. 16(12), pages 1345-1357.
    4. Stefano Conti & Karl Claxton, 2008. "Dimensions of design space: a decision-theoretic approach to optimal research design," Working Papers 038cherp, Centre for Health Economics, University of York.
    5. Klemen Naveršnik, 2015. "Output correlations in probabilistic models with multiple alternatives," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(2), pages 133-139, March.
    6. Michal Jakubczyk, 2016. "Choosing from multiple alternatives in cost-effectiveness analysis with fuzzy willingness-to-pay/accept and uncertainty," KAE Working Papers 2016-006, Warsaw School of Economics, Collegium of Economic Analysis.
    7. Andrija S Grustam & Nasuh Buyukkaramikli & Ron Koymans & Hubertus J M Vrijhoef & Johan L Severens, 2019. "Value of information analysis in telehealth for chronic heart failure management," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-23, June.
    8. Garry Barton & Tracey Sach & Michael Doherty & Anthony Avery & Claire Jenkinson & Kenneth Muir, 2008. "An assessment of the discriminative ability of the EQ-5D index , SF-6D, and EQ VAS, using sociodemographic factors and clinical conditions," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 9(3), pages 237-249, August.
    9. Pedram Sendi, 2021. "Dealing with Bad Risk in Cost-Effectiveness Analysis: The Cost-Effectiveness Risk-Aversion Curve," PharmacoEconomics, Springer, vol. 39(2), pages 161-169, February.
    10. Casey Quinn, 2005. "Generalisable regression methods for costeffectiveness using copulas," Health, Econometrics and Data Group (HEDG) Working Papers 05/13, HEDG, c/o Department of Economics, University of York.
    11. Simon Eckermann & Andrew Willan, 2011. "Presenting Evidence and Summary Measures to Best Inform Societal Decisions When Comparing Multiple Strategies," PharmacoEconomics, Springer, vol. 29(7), pages 563-577, July.
    12. Nadja Chernyak & Heribert Sattel & Marsel Scheer & Christina Baechle & Johannes Kruse & Peter Henningsen & Andrea Icks, 2014. "Economic Evaluation of Brief Psychodynamic Interpersonal Therapy in Patients with Multisomatoform Disorder," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-4, January.
    13. Mohan V. Bala & Gary A. Zarkin & Josephine Mauskopf, 2008. "Presenting results of probabilistic sensitivity analysis: the incremental benefit curve," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 435-440, March.
    14. Rachael L. Fleurence, 2007. "Setting priorities for research: a practical application of ‘payback’ and expected value of information," Health Economics, John Wiley & Sons, Ltd., vol. 16(12), pages 1345-1357, December.
    15. N. J. Welton & A. E. Ades & D. M. Caldwell & T. J. Peters, 2008. "Research prioritization based on expected value of partial perfect information: a case‐study on interventions to increase uptake of breast cancer screening," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 171(4), pages 807-841, October.
    16. Hester V Eeren & Saskia J Schawo & Ron H J Scholte & Jan J V Busschbach & Leona Hakkaart, 2015. "Value of Information Analysis Applied to the Economic Evaluation of Interventions Aimed at Reducing Juvenile Delinquency: An Illustration," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-15, July.
    17. Elisabeth Fenwick & Karl Claxton & Mark Sculpher, 2005. "The value of implementation and the value of information: combined and uneven development," Working Papers 005cherp, Centre for Health Economics, University of York.
    18. Sharma, Rajiv & Stano, Miron & Haas, Mitchell, 2004. "Adjusting to changes in health: implications for cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 23(2), pages 335-351, March.
    19. Sennen Hounton & David Newlands, 2012. "Applying the Net-Benefit Framework for Analyzing and Presenting Cost-Effectiveness Analysis of a Maternal and Newborn Health Intervention," PLOS ONE, Public Library of Science, vol. 7(7), pages 1-8, July.
    20. Joan Costa-Fonta & Montserrat Font-Vilalta, "undated". "The limits on the Design of Long-Term Care Insurance Schemes in Spain stas," Studies on the Spanish Economy 201, FEDEA.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:sae:medema:v:27:y:2007:i:2:p:161-177. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: SAGE Publications (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.