LETTER
Cost-Effectiveness of Echocardiography after Stroke
James R. Korb, MD
15 May 1998 | Volume 128 Issue 10 | Pages 872-873
TO THE EDITOR:
McNamara and colleagues [1] showed that TEE is more cost-effective than TTE in ischemic stroke. They also concluded that all patients with new-onset stroke should have TEE. I do not think that their study supports the latter conclusion. In calculating costs for TEE, the authors included only the cost of the test. It is most likely that if all patients with new-onset stroke were to receive TEE, the average length of hospital stay for strokes would be increased.
The authors also estimate an 8% rate of cardiac thrombus and a 33% reduction in the rate of recurrent stroke if these patients were treated with anticoagulation. Thus, for 1000 patients with new ischemic stroke, 1000 TEE studies would be performed and 80 patients with cardiac thrombus would be detected. By treating these 80 patients for 1 year with warfarin, 10 recurrent strokes would be prevented at a cost of one cerebral hemorrhage and two cases of gastrointestinal bleeding. It does not seem reasonable to do a procedure involving conscious sedation on 1000 patients to potentially benefit 9 of them.
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Author and Article Information
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Los Angeles, CA 90034
1. McNamara RL, Lima JA, Whelton PK, Powe NR. Echocardiographic identification of cardiovascular sources of emboli to guide clinical management of stroke: a cost-effectiveness analysis. Ann Intern Med. 1997; 127:775-87.
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