{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T17:38:08Z","timestamp":1772213888936,"version":"3.50.1"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2022,6,3]],"date-time":"2022-06-03T00:00:00Z","timestamp":1654214400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Closure of a patent foramen ovale reduces the risk of recurrent stroke compared with medical therapy alone in young patients with cryptogenic strokes revealed by randomized control trials. Some cost-effectiveness analyses outside Japan have shown that patent foramen ovale closure is cost-effective, but no studies have examined cost-effectiveness in Japan. The objective of this study is to assess cost-effectiveness, from the perspective of a Japanese healthcare payer, of patent foramen ovale closure versus medical therapy alone for patients with patent foramen ovale related to cryptogenic strokes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cost-effectiveness study was conducted by developing a decision tree and a Markov model. Probabilities and a 5.9-year time horizon followed the RESPECT study. Utilities and costs were based upon published studies and assumptions. All assumptions were assessed by experts, including a cardiologist and a statistical expert. The target population comprised patients with cryptogenic stroke and patent foramen ovale, aged 60 years or younger. The model was discounted at 2.0% and its cycle was one month. A willingness-to-pay threshold is set at $50,000 \/ quality-adjusted life years (QALYs). Incremental cost-effectiveness ratio was evaluated. Then one-way sensitivity analyses as deterministic sensitivity analysis, and probabilistic sensitivity analyses were performed to assess data robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Incremental quality-adjusted life years, incremental costs, and incremental cost-effectiveness ratio were 0.464, $13,562, and $29,208 per QALY gained, respectively. One-way sensitivity analysis showed that the stable state utility score difference between patent foramen ovale closure and medical therapy had the largest impact on incremental cost-effectiveness ratio. Patent foramen ovale closure is cost-effective at a stable state utility score difference of &gt;0.051, compared with medical therapy. Probabilistic sensitivity analyses demonstrated that patent foramen ovale closure was 50.3% cost-effective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patent foramen ovale closure was cost-effective compared with medical therapy for Japanese patients with cryptogenic stroke who were \u226460 years.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0268690","type":"journal-article","created":{"date-parts":[[2022,6,3]],"date-time":"2022-06-03T13:48:24Z","timestamp":1654264104000},"page":"e0268690","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Cost-effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8175-3845","authenticated-orcid":true,"given":"Yoko","family":"Shijoh","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shota","family":"Saito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0363-7563","authenticated-orcid":true,"given":"Zhehao","family":"Dai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sachiko","family":"Ohde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,6,3]]},"reference":[{"issue":"7","key":"pone.0268690.ref001","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1161\/CIRCULATIONAHA.104.524371","article-title":"Patent foramen ovale and stroke","volume":"112","author":"S Homma","year":"2005","journal-title":"Circulation"},{"issue":"3","key":"pone.0268690.ref002","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1038\/nrcardio.2010.224","article-title":"Patent foramen ovale: Anatomy, outcomes, and closure.","volume":"8","author":"PA Calvert","year":"2011","journal-title":"Nat Rev Cardiol"},{"issue":"4","key":"pone.0268690.ref003","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1016\/j.jacc.2006.02.074","article-title":"Young Adult Myocardial Infarction and Ischemic Stroke. The Role of Paradoxical Embolism and Thrombophilia (The YAMIS Study).","volume":"48","author":"S Sastry","year":"2006","journal-title":"J Am Coll Cardiol"},{"key":"pone.0268690.ref004","author":"Japan Stroke Society","year":"2019","journal-title":"Guidance of patent foramen ovale closure for cryptogenic ischemic stroke"},{"issue":"11","key":"pone.0268690.ref005","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1056\/NEJMoa1610057","article-title":"Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke","volume":"377","author":"JL Saver","year":"2017","journal-title":"N Engl J Med"},{"issue":"11","key":"pone.0268690.ref006","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1056\/NEJMoa1707404","article-title":"Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke","volume":"377","author":"L S\u00f8ndergaard","year":"2017","journal-title":"N Engl J 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