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Cost-Effectiveness of Echocardiography after Stroke
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
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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.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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