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Echocardiographic risk stratification for early surgery with endocarditis: a cost-effectiveness analysis.

Publication ,  Journal Article
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 in: Heart (British Cardiac Society)
May 2008

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.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").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%.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.

Duke Scholars

Published In

Heart (British Cardiac Society)

DOI

EISSN

1468-201X

ISSN

1355-6037

Publication Date

May 2008

Volume

94

Issue

5

Start / End Page

e18

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Sensitivity and Specificity
  • Risk Assessment
  • Quality-Adjusted Life Years
  • Markov Chains
  • Humans
  • Endocarditis
  • Echocardiography
  • Early Diagnosis
 

Citation

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Liao, L., Kong, D. F., Samad, Z., Pappas, P. A., Jollis, J. G., Lin, S. S., … Cabell, C. H. (2008). Echocardiographic risk stratification for early surgery with endocarditis: a cost-effectiveness analysis. Heart (British Cardiac Society), 94(5), e18. https://doi.org/10.1136/hrt.2006.106716
Liao, L., D. F. Kong, Z. Samad, P. A. Pappas, J. G. Jollis, S. S. Lin, A. Wang, et al. “Echocardiographic risk stratification for early surgery with endocarditis: a cost-effectiveness analysis.Heart (British Cardiac Society) 94, no. 5 (May 2008): e18. https://doi.org/10.1136/hrt.2006.106716.
Liao L, Kong DF, Samad Z, Pappas PA, Jollis JG, Lin SS, et al. Echocardiographic risk stratification for early surgery with endocarditis: a cost-effectiveness analysis. Heart (British Cardiac Society). 2008 May;94(5):e18.
Liao, L., et al. “Echocardiographic risk stratification for early surgery with endocarditis: a cost-effectiveness analysis.Heart (British Cardiac Society), vol. 94, no. 5, May 2008, p. e18. Epmc, doi:10.1136/hrt.2006.106716.
Liao L, Kong DF, Samad Z, Pappas PA, Jollis JG, Lin SS, Wang A, Fowler VG, Chu VH, Sexton DJ, Corey GR, Cabell CH. Echocardiographic risk stratification for early surgery with endocarditis: a cost-effectiveness analysis. Heart (British Cardiac Society). 2008 May;94(5):e18.

Published In

Heart (British Cardiac Society)

DOI

EISSN

1468-201X

ISSN

1355-6037

Publication Date

May 2008

Volume

94

Issue

5

Start / End Page

e18

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Sensitivity and Specificity
  • Risk Assessment
  • Quality-Adjusted Life Years
  • Markov Chains
  • Humans
  • Endocarditis
  • Echocardiography
  • Early Diagnosis