Cost-effectiveness of outpatient cardiac monitoring to detect atrial fibrillation after ischemic stroke.
OBJECTIVE
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.
Department of Neurology. University of California, San Francisco, Calif, USA. hooman.kamel@ucsf.edu
Hooman
H
Kamel
Manu
M
Hegde
Derek R
DR
Johnson
Brian F
BF
Gage
S Claiborne
SC
Johnston
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000191:economics* / Q000209:etiology / Q000503:physiopathology; D002545:Brain Ischemia / Q000150:complications / Q000191:economics* / Q000503:physiopathology; D003362:Cost-Benefit Analysis / Q000191:economics; D015716:Electrocardiography, Ambulatory / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D018670:Monitoring, Ambulatory / Q000191:economics; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000150:complications / Q000191:economics* / Q000503:physiopathology; D016896:Treatment Outcome