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Análisis de costo-efectividad de estrategias alternativas en el manejo de pacientes con accidente cerebrovascular criptogénico y foramen oval permeable;
Cost-Effectiveness Analysis of Alternative Strategies for the Management of Patients with Cryptogenic Stroke and Patent Foramen Ovale

Creators:Arias, Anibal; Hospital Italiano de Buenos Aires - Servicio de Cardiología, Masson, Walter M.; Hospital Italiano de Buenos Aires - Servicio de Cardiología, Bluro, Ignacio M.; Hospital Italiano de Buenos Aires - Servicio de Cardiología, Oberti, Pablo F.; Hospital Italiano de Buenos Aires - Servicio de Cardiología, Falconi, Mariano L.; Hospital Italiano de Buenos Aires - Servicio de Cardiología, Pizarro, Rodolfo; Hospital Italiano de Buenos Aires - Servicio de Cardiología, Krauss, Juan G.; Hospital Italiano de Buenos Aires - Servicio de Cardiología, Cagide, Arturo M.; Hospital Italiano de Buenos Aires - Servicio de Cardiología
2011-09-26

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Descripción

AntecedentesEl foramen oval permeable (FOP) se ha asociado con el accidente cerebrovascular criptogénico(ACVC). El mejor tratamiento para evitar la recidiva en pacientes con ACVC y FOP es controversial.No existen datos de costo-utilidad en nuestra región para el manejo de estos pacientes.ObjetivosConstruir un modelo de decisión para el manejo de pacientes con ACVC y FOP y establecerla relación costo-utilidad de tres estrategias alternativas.Material y métodosSe realizó un análisis de costo-utilidad basado en un árbol de decisión con un horizontetemporal de 4 años considerando tres estrategias: aspirina (AAS), anticoagulación (ACO) ocierre percutáneo del FOP con dispositivo. Los beneficios se expresaron en QALYs. Se fijó unumbral de pago de $28.000 argentinos y se realizó un análisis de sensibilidad.ResultadosEn comparación con la AAS, la anticoagulación fue más costosa ($1.315 adicionales) y generómenos beneficios (QALY incremental –0,063). El cierre con dispositivo comparado con eltratamiento con AAS costaría $89.876 adicionales por QALY ganado. Dicho monto supera elumbral de pago predeterminado. Luego del análisis de sensibilidad, la AAS se mantuvo comola estrategia con mejor relación costo-utilidad, salvo cuando la probabilidad de recidiva conesta droga aumenta al 35%, en donde la anticoagulación presenta una tasa de costo-utilidadincremental de $1.356/QALY.ConclusiónDe acuerdo con este modelo, para pacientes con ACVC y FOP, la AAS sería la estrategia conmejor relación costo-utilidad en nuestro medio, salvo cuando la probabilidad de eventos seeleva sustancialmente, en cuyo caso sería apropiado el uso de anticoagulantes.

BackgroundPatent foramen ovale (PFO) has been associated with cryptogenicstroke (CS). There are still some controversies aboutthe best treatment to prevent recurrences in patients withCS and PFO. Our region lacks cost-utility analysis of themanagement of these patients.ObjectivesTo construct a decision model for the management of patientswith CS and PFO and to establish the cost-utility ratio ofthree alternative strategies.Material and MethodsWe conducted a cost-utility analysis based on a decision treewith a time horizon of 4 years considering three strategies:aspirin (ASA), anticoagulants (AC) or percutaneous deviceclosure of the PFO. The benefits were expressed in QALYs.A payment threshold of ARS $28,000 was established and asensitivity analysis was performed.ResultsAnticoagulants were more expensive compared to ASA (additionalcost of ARS $1,315) and produced less benefits (incremental(QALY –0.063). Percutaneous device closure had anadditional cost of ARS $89,876 per QALY gained compared toASA. This cost exceeds the predetermined payment threshold.After performing the sensitivity analysis, ASA remained asthe strategy with the best cost-utility ratio; however, whenthe probability of recurrences with this drug increases to35%, anticoagulants present an incremental cost-utility ratioof ARS $1.356/QALY.ConclusionAccording to this model, in patients with CS and PFO, ASAwould be the strategy with the best cost-utility ratio in ourenvironment unless recurrences develop; in this case the useof anticoagulants would be more appropriate.

Metadatos destacados

Colecciones
Argentine Journal of Cardiology

Editor

Sociedad Argentina de Cardiología

Fuente

Revista Argentina de Cardiología; Vol 79, No 4 (2011); 337-343, Argentine Journal of Cardiology; Vol 79, No 4 (2011); 337-343

Citación

Arias, Anibal; Hospital Italiano de Buenos Aires - Servicio de Cardiología et al., “Análisis de costo-efectividad de estrategias alternativas en el manejo de pacientes con accidente cerebrovascular criptogénico y foramen oval permeable,” Archivo PPCT, consulta 1 de abril de 2026, http://archivoppct.caicyt.gov.ar/items/show/7861.

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Materia

Autor

Arias, Anibal; Hospital Italiano de Buenos Aires - Servicio de Cardiología
Masson, Walter M.; Hospital Italiano de Buenos Aires - Servicio de Cardiología
Bluro, Ignacio M.; Hospital Italiano de Buenos Aires - Servicio de Cardiología
Oberti, Pablo F.; Hospital Italiano de Buenos Aires - Servicio de Cardiología
Falconi, Mariano L.; Hospital Italiano de Buenos Aires - Servicio de Cardiología
Pizarro, Rodolfo; Hospital Italiano de Buenos Aires - Servicio de Cardiología
Krauss, Juan G.; Hospital Italiano de Buenos Aires - Servicio de Cardiología
Cagide, Arturo M.; Hospital Italiano de Buenos Aires - Servicio de Cardiología

Fuente

Revista Argentina de Cardiología; Vol 79, No 4 (2011); 337-343
Argentine Journal of Cardiology; Vol 79, No 4 (2011); 337-343

Editor

Sociedad Argentina de Cardiología

Fecha

2011-09-26

Derechos

Los que firman al pié, certificamos que tenemos total responsabilidad por la conducción de este estudio y por el diseño y la interpretación de los datos. Nosotros escribimos el manuscrito y somos responsables por la decisión acerca del mismo. Cada uno de nosotros cumple la definición de autor como se afirma en el Comité Internacional de Editores de Revistas Médicas (International Committee of Medical Journal Editors, ver www.icmje.org). Nosotros hemos visto y aprobado el manuscrito final. Ni el artículo, ni ninguna parte esencial del mismo, incluido las tablas y las figuras, será publicado o admitido para arbitrar a otra parte antes de aparecer en la Revista.También notificamos haber leído la sección “conflicto de intereses”, y revelaríamos cualquiera que existiera. Dejamos constancia que si nuestro artículo se publicara en la RAC, cederíamos los derechos (copyright) a la Revista.Los documentos publicados en esta revista están bajo la licencia Creative Commons Atribución-NoComercial-Compartir-Igual 2.5 Argentina.
Those signing below certify that we have full responsibility for the conduction of this study and for the design and interpretation of the information. We wrote the manuscript and are responsible for its decision. Each of us fulfills the definition of authorship as stated by the International Committee of Medical Journal Editors ( www.icmje.org). We have signed and approved the final manuscript. Neither the manuscript, nor any essential part thereof, including tables and figures, will be published or accepted for refereeing elsewhere before being published in the Journal. We have also read the "Conflict of Interest" section and would disclose any existing. We state that if our manuscript is published in the RAC, we shall transfer the copyright to the Journal.

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spa
eng

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info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion