Análisis de costo-efectividad de estrategias alternativas en el manejo de pacientes con accidente cerebrovascular criptogénico y foramen oval permeable

background patent foramen ovale (pfo) has been associated with cryp-togenic stroke (cs). there are still some controversies about the best treatment to prevent recurrences in patients with cs and pfo. our region lacks cost-utility analysis of the management of these patients. objectives to construct a decision model for the management of patients with cs and pfo and to establish the cost-utility ratio of three alternative strategies. material and methods we conducted a cost-utility analysis based on a decision tree with a time horizon of 4 years considering three strategies: aspirin (asa), anticoagulants (ac) or percutaneous device closure of the pfo. the benefits were expressed in qalys. a payment threshold of ars $28,000 was established and a sensitivity analysis was performed. results anticoagulants were more expensive compared to asa (additional cost of ars $1,315) and produced less benefits (incremental (qaly -0.063). percutaneous device closure had an additional cost of ars $89,876 per qaly gained compared to asa. this cost exceeds the predetermined payment threshold. after performing the sensitivity analysis, asa remained as the strategy with the best cost-utility ratio; however, when the probability of recurrences with this drug increases to 35%, anticoagulants present an incremental cost-utility ratio of ars $1.356/qaly. conclusion according to this model, in patients with cs and pfo, asa would be the strategy with the best cost-utility ratio in our environment unless recurrences develop; in this case the use of anticoagulants would be more appropriate.