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dc.contributor.authorMayer, Felixen_US
dc.contributor.authorStahrenberg, Raoulen_US
dc.contributor.authorGröschel, Klausen_US
dc.contributor.authorMostardt, Sarahen_US
dc.contributor.authorBiermann, Janineen_US
dc.contributor.authorEdelmann, Franken_US
dc.contributor.authorLiman, Janen_US
dc.contributor.authorWasem, Jürgenen_US
dc.contributor.authorGoehler, Alexanderen_US
dc.contributor.authorWachter, Rolfen_US
dc.contributor.authorNeumann, Anjaen_US
dc.date.accessioned2014-03-11T10:17:43Z
dc.date.issued2013en_US
dc.identifier.citationMayer, F., R. Stahrenberg, K. Gröschel, S. Mostardt, J. Biermann, F. Edelmann, J. Liman, et al. 2013. “Cost-effectiveness of 7-day-Holter monitoring alone or in combination with transthoracic echocardiography in patients with cerebral ischemia.” Clinical Research in Cardiology 102 (1): 875-884. doi:10.1007/s00392-013-0601-2. http://dx.doi.org/10.1007/s00392-013-0601-2.en
dc.identifier.issn1861-0684en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:11879415
dc.description.abstractBackground and purpose Prolonged 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. Methods: Lifetime 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). Results: Predicted 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. Conclusions: A 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.en
dc.language.isoen_USen
dc.publisherSpringer Berlin Heidelbergen
dc.relation.isversionofdoi:10.1007/s00392-013-0601-2en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826055/pdf/en
dash.licenseLAAen_US
dc.subjectAtrial fibrillationen
dc.subjectStrokeen
dc.subjectHolter monitoringen
dc.subjectCost-effectivenessen
dc.subjectMarkov modelen
dc.titleCost-effectiveness of 7-day-Holter monitoring alone or in combination with transthoracic echocardiography in patients with cerebral ischemiaen
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalClinical Research in Cardiologyen
dash.depositing.authorGoehler, Alexanderen_US
dc.date.available2014-03-11T10:17:43Z
dc.identifier.doi10.1007/s00392-013-0601-2*
dash.authorsorderedfalse
dash.contributor.affiliatedGoehler, Alexander


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