Infective endocarditis treatment proves cost-effective with ultrasound

Echocardiography is already widely accepted as a diagnostic test for infective endocarditis, but now researchers have proven it's also a cost-effective option. Making decisions about early surgery for patients with significant stroke risk based on echocardiographic findings is ultimately more economical than standard care.

Dr. Lawrence Liao and colleagues at Duke University published the results of their cost-effectiveness analysis in the June 17, 2007 issue of Heart. They used previously published and internal institutional data to construct a decision tree and Markov analysis model investigating the cost-effectiveness of echocardiography in a risk-stratification strategy for infective endocarditis.

Patients treated for infective endocarditis were divided into two groups. The first was composed of high-risk patients who were given standard care, using clinical factors to make decisions about early surgery. The second group was made up of high-risk patients who had surgery guided by echocardiographic findings. The analytic models compared cost-effectiveness of the different methods in each group.

The researchers found the cost per patient receiving standard care was $47,766 with 5.86 expected quality-adjusted life years (QALY). The cost per patient with echocardiography-guided strategies was $53,669 with 6.10 expected QALY. The echo-guided strategy cost an additional $23,867 per QALY saved.

One-way sensitivity analysis showed the incremental cost remained less than $50,000 per quality-adjusted life year across a wide range of scenarios, with baseline stroke risk having the greatest effect on cost effectiveness.

When the stroke risk for patients was less than 3.65%, the incremental cost-effectiveness ratio was greater than $50,000 per QALY for the echo-guided strategy. At stroke risk between 3.65% and 14%, the incremental cost-effectiveness ratio for the echo-guided strategy dropped below $50,000 per QALY. But when the baseline stroke risk rose above 18.3%, the echo-guided strategy was economically superior to standard care.

The researchers concluded that an echocardiography-guided risk stratification strategy for early surgery is a cost-attractive treatment for infective endocarditis, as it improves outcome for a relatively small incremental cost.