PT  - JOURNAL ARTICLE
AU  - L Liao
AU  - D F Kong
AU  - Z Samad
AU  - P A Pappas
AU  - J G Jollis
AU  - S S Lin
AU  - A Wang
AU  - V G Fowler, Jr
AU  - V H Chu
AU  - D J Sexton
AU  - G R Corey
AU  - C H Cabell
TI  - Echocardiographic risk stratification for early surgery with endocarditis: a cost-effectiveness analysis
AID  - 10.1136/hrt.2006.106716
DP  - 2008 May 01
TA  - Heart
PG  - e18--e18
VI  - 94
IP  - 5
4099  - http://heart.bmj.com/content/94/5/e18.short
4100  - http://heart.bmj.com/content/94/5/e18.full
SO  - Heart2008 May 01; 94
AB  - Background: 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. Methods: 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”). Results: 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%. Conclusion: 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.