{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T20:05:02Z","timestamp":1792872302790,"version":"4.5.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>Percutaneous transcatheter closure of patent foramen ovale (PFO closure) plus antiplatelet therapy has been shown to reduce the risk of recurrent stroke compared with medical therapy alone in carefully selected patients after cryptogenic stroke presumed to be from paradoxical embolism. Our objective was to determine the cost-effectiveness of PFO closure after cryptogenic stroke compared with conservative medical management from a US healthcare payer perspective.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>A decision analytic Markov model estimated the 15-year cost and outcomes associated with the additional benefit of PFO closure compared with medical management alone. Model inputs were obtained from published literature, national databases, and a meta-analysis of 5 published randomized clinical trials on PFO closure. Health outcomes were measured in quality-adjusted life years (QALY). Cost-effectiveness used the incremental cost per QALY gained, whereas the net monetary benefit assumed a willingness to pay of $150\u2009000\/QALY. One-way and probabilistic sensitivity analyses estimated the uncertainty of model results.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>At 15 years, PFO closure compared with medical therapy alone improved QALY by 0.33 at a cost saving of $3568, representing an incremental net monetary benefit of $52\u2009761 (95% interval \u2212$8284 to $158\u2009910). When the meta-analysis hazard ratio for stroke was increased to the 95% interval\u2019s upper bound of 0.77, one-way sensitivity analyses suggested that PFO closure\u2019s cost-effectiveness was $458\u2009558 per additional QALY. Probabilistic sensitivity analysis suggested cost-effectiveness in 90% of simulation runs.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>PFO closure for cryptogenic strokes in the right setting is cost-effective, producing benefit in QALYs gained and potential cost savings. However, patient selection remains vitally important as marginal declines in treatment effectiveness can dramatically affect cost-effectiveness.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.117.020322","type":"journal-article","created":{"date-parts":[[2018,5,2]],"date-time":"2018-05-02T09:05:14Z","timestamp":1525251914000},"page":"1443-1450","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":49,"title":["Cost-Effectiveness of Patent Foramen Ovale Closure Versus Medical Therapy for Secondary Stroke Prevention"],"prefix":"10.1161","volume":"49","author":[{"given":"Michelle H.","family":"Leppert","sequence":"first","affiliation":[{"name":"From the Department of Neurology (M.H.L., S.N.P., K.D.O.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon N.","family":"Poisson","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (M.H.L., S.N.P., K.D.O.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Carroll","sequence":"additional","affiliation":[{"name":"Division of Cardiology (J.D.C., P.M.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Thaler","sequence":"additional","affiliation":[{"name":"Department of Neurology, Tufts University School of Medicine, Boston, MA (D.E.T.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong H.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy (C.H.K., J.D.C.), University of Colorado Denver, Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen D.","family":"Orjuela","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (M.H.L., S.N.P., K.D.O.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. Michael","family":"Ho","sequence":"additional","affiliation":[{"name":"Division of Cardiology (J.D.C., P.M.H.)"},{"name":"Cardiology Section, VA Eastern Colorado Health Care System, Denver (P.M.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James F.","family":"Burke","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Michigan Health System, Ann Arbor (J.F.B.)"},{"name":"Department of Neurology, Ann Arbor VA, MI (J.F.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy (C.H.K., J.D.C.), University of Colorado Denver, Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410250410"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(12)60336-X"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198805053181802"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009639"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1211716"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1301440"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.12.023"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1705915"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1707404"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1610057"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.009779"},{"key":"e_1_3_3_13_2","unstructured":"St Jude Medical Inc Medical Device Panel. 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