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Stroke. 2010 Jul;41(7):1514-20. doi: 10.1161/STROKEAHA.110.582437. Epub 2010 May 27.

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

Author information

  • 1Department of Neurology. University of California, San Francisco, Calif, USA. hooman.kamel@ucsf.edu

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.

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PMID:
20508188
[PubMed - indexed for MEDLINE]
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