Echocardiographic risk stratification for early surgery with endocarditis: a cost-effectiveness analysis.
Journal Article (Journal Article)
BACKGROUND: Despite widespread acceptance of echocardiography for diagnosis of infective endocarditis, few investigators have evaluated its utility as a risk-stratification tool to aid therapeutic decision-making. METHODS: A decision tree and Markov analysis model were constructed using published and institutional data to estimate the cost-effectiveness of an echocardiographic risk-stratification strategy for infective endocarditis. The models compared surgery for high-risk patients based on clinical factors ("standard care") and surgery for high-risk patients based on echocardiographic findings ("echocardiography-guided"). RESULTS: The cost per patient for standard care and echocardiography-guided strategies was $47,766 and $53,669, respectively. The expected quality-adjusted life years (QALY) for standard care and echocardiography-guided strategies were 5.86 years and 6.10 years, respectively. Compared with standard care, the echocardiography-guided strategy cost an additional $23,867 per QALY saved. In one-way sensitivity analyses, the incremental cost of this strategy remained <$50,000/QALY across a broad range of scenarios. Baseline stroke risk had the greatest effect on cost-effectiveness. For populations with stroke risk less than 3.65%, the echocardiography-guided strategy was not cost-attractive (ICER >$50,000/QALY). At stroke risk between 3.65% and 14%, the ICER for the echocardiography-guided strategy was attractive (<$50,000 /QALY). The echocardiography-guided strategy became economically dominant at any baseline stroke risk greater than 18.3%. CONCLUSION: Echo-guided risk stratification for early surgery in patients with large vegetations is a cost-attractive treatment strategy for IE, as it improves outcome for an incremental cost <$50,000/QALY.
Full Text
Duke Authors
- Chu, Vivian Hou
- Corey, Gordon Ralph
- Fowler Jr., Vance Garrison
- Jollis, James Gerard
- Kong, David Franklin
- Liao, Lawrence
- Lin, Shu Shiuh-Shi
- Samad, Zainab
- Sexton, Daniel John
- Wang, Andrew
Cited Authors
- Liao, L; Kong, DF; Samad, Z; Pappas, PA; Jollis, JG; Lin, SS; Wang, A; Fowler, VG; Chu, VH; Sexton, DJ; Corey, GR; Cabell, CH
Published Date
- May 2008
Published In
Volume / Issue
- 94 / 5
Start / End Page
- e18 -
PubMed ID
- 17575328
Electronic International Standard Serial Number (EISSN)
- 1468-201X
Digital Object Identifier (DOI)
- 10.1136/hrt.2006.106716
Language
- eng
Conference Location
- England