Cost-effectiveness of 7-day-Holter monitoring alone or in combination with transthoracic echocardiography in patients with cerebral ischemiaReportar como inadecuado

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Clinical Research in Cardiology

, Volume 102, Issue 12, pp 875–884

First Online: 02 August 2013Received: 14 June 2013Accepted: 17 July 2013


Background and purposeProlonged Holter monitoring of patients with cerebral ischemia increases the detection rate of paroxysmal atrial fibrillation PAF; this leads to improved antithrombotic regimens aimed at preventing recurrent ischemic strokes. The aim of this study was to compare a 7-day-Holter monitoring 7-d-Holter alone or in combination with prior selection via transthoracic echocardiography TTE to a standard 24-h-Holter using a cost-utility analysis.

MethodsLifetime cost, quality-adjusted life years QALY, and incremental cost-effectiveness ratios ICER were estimated for a cohort of patients with acute cerebral ischemia and no contraindication to oral anticoagulation. A Markov model was developed to simulate the long-term course and progression of cerebral ischemia considering the different diagnostic algorithms 24-h-Holter, 7-d-Holter, 7-d-Holter after preselection by TTE. Clinical data for these algorithms were derived from the prospective observational Find-AF study ISRCTN 46104198.

ResultsPredicted lifelong discounted costs were 33,837 € for patients diagnosed by the 7-d-Holter and 33,852 € by the standard 24-h-Holter. Cumulated QALYs were 3.868 for the 7-d-Holter compared to 3.844 for the 24-h-Holter. The 7-d-Holter dominated the 24-h-Holter in the base-case scenario and remained cost-effective in extensive sensitivity analysis of key input parameter with a maximum of 8,354 €-QALY gained. Preselecting patients for the 7-d-Holter had no positive effect on the cost-effectiveness.

ConclusionsA 7-d-Holter to detect PAF in patients with cerebral ischemia is cost-effective. It increases the detection which leads to improved antithrombotic regimens; therefore, it avoids recurrent strokes, saves future costs, and decreases quality of life impairment. Preselecting patients by TTE does not improve cost-effectiveness.

KeywordsAtrial fibrillation Stroke Holter monitoring Cost-effectiveness Markov model F. Mayer and R. Stahrenberg contributed equally and share first authorship. R. Wachter and A. Neumann share last authorship.

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Autor: Felix Mayer - Raoul Stahrenberg - Klaus Gröschel - Sarah Mostardt - Janine Biermann - Frank Edelmann - Jan Liman - Jürgen


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