Economic evaluation of prolonged and enhanced ECG Holter monitoring in acute ischemic stroke patients.
Objective: Atrial fibrillation (AF) is a major cause for recurrent stroke, has severe impact on a patient's health and imposes a high economic burden for society. Current guidelines recommend 24 h ECG monitoring (standard-of-care, SoC) to detect AF after stroke to reduce the risk of future events. However, paroxysmal AF (PAF) is difficult to detect within this period as it occurs infrequently and unpredictably. In a randomized controlled trial (Find-AFRANDOMISED), prolonged and enhanced Holter ECG monitoring (EPM) revealed a significantly higher detection rate of AF compared to SoC, although its cost-effectiveness has not yet been investigated. Methods: Based on the data of FIND-AFRANDOMISED, an economic evaluation was conducted. One group received EPM for 10 days after the event, and at 3 and 6 months; the other group received SoC. Healthcare resource use and quality of life (QoL) data were measured at baseline, and after 6 and 12 months. Incremental costs and quality-adjusted life years (QALYs) between both groups were compared. Non-parametric bootstrapping and one-way-sensitivity analyses were performed. Results: A total of 281 patients with healthcare resource use and QoL data for all measurement points were considered in the economic evaluation (complete case analysis, CCA). The CCA yielded nonsignificant 315€ lower mean costs and 0.0013 less QALYs for patients receiving EPM with no statistically significant differences in any cost categories. Sensitivity analyses revealed robust results. Bootstrapping the results indicated moderate probability of cost-effectiveness. Conclusions: EPM yielded reduced not significantly different costs without affecting QoL and may be a useful strategy to detect PAF in acute ischemic stroke patients in time.
['Diekmann|Sandra|S|', 'Hörster|Laura|L|', 'Evers|Silvia|S|0000-0003-1026-570X', 'Hiligsmann|Mickaël|M|0000-0003-4274-9258', 'Gelbrich|Götz|G|', 'Gröschel|Klaus|K|', 'Wachter|Rolf|R|', 'Hamann|Gerhard F|GF|', 'Kermer|Pawel|P|', 'Liman|Jan|J|', 'Weber-Krüger|Mark|M|', '|||', 'Wasem|Jürgen|J|', 'Neumann|Anja|A|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D001281:Atrial Fibrillation D002545:Brain Ischemia D003362:Cost-Benefit Analysis D015716:Electrocardiography, Ambulatory D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D011788:Quality of Life D019057:Quality-Adjusted Life Years D020521:Stroke
stroke Atrial fibrillation quality-adjusted life years cost–benefit analysis secondary prevention