Fig 1.
A decision tree shows that a patient who had a PFO enters this model after a cryptogenic stroke and is assigned either a PFO closure or medical treatment. PFO closure has three possible outcomes: complication, non-complication, or death. Abbreviations. PFO, patent foramen ovale.
Fig 2.
The Markov model shows four health states: stable after cryptogenic stroke, post-minor recurrent stroke, post-moderate recurrent stroke, and death. We used a modified Rankin Scale to categorize strokes. Abbreviations. PFO, patent foramen ovale; mRS, modified Rankin Scale.
Table 1.
Probabilities of events, life years, and utility scores for base model inputs and sensitivity analyses.
Table 2.
Base case cost-effectiveness analysis.
Fig 3.
One-way sensitivity analysis of PFO closure VS medical therapy.
The impact of parameter variation using a willingness-to-pay threshold of $50,000/QALY. The hatched bars and black bars show the upper (high estimate) and lower values of the parameter, respectively. Bars are aligned in order of impact from largest to smallest. Abbreviations. PFO, patent foramen ovale; mRS, modified Rankin Scale; DOAC, novel direct oral anticoagulants.
Fig 4.
One-way sensitivity analysis: The stable state utility score difference between PFO closure and medical therapy.
The stable state utility score difference between PFO closure and medical therapy, which is the largest impact of parameter variation, is shown with ICER. The dashed line represents a willingness-to-pay (WTP) threshold of $50,000 /QALY and a utility score difference of 0.051 at that WTP threshold. Abbreviations. WTP, willingness-to-pay; ICER, incremental cost-effectiveness ratio.
Fig 5.
One-way sensitivity analysis: Time horizon closure vs. medical therapy.
Time horizon closure vs. medical therapy, which is the second largest impact of parameter variation, is shown with ICER. Abbreviations. ICER, incremental cost-effectiveness ratio.
Fig 6.
Cost-effectiveness acceptability curves.
Willingness-to-pay ($) is shown with percent cost-effectiveness. The dashed line is a willingness-to-pay threshold (WTP) of $50,000/QALY and the percent cost effectiveness is 50.3% at a WTP of $50,000/QALY. Abbreviations. WTP, Willingness-to-pay.