Economic evaluation of percutaneous patent foramen ovale closure versus medical therapy in patients with a cryptogenic stroke: a systematic review

INTRODUCTION: The risk of recurrent ischemic strokes in young to middle-aged patients who have experienced a recent cryptogenic ischemic stroke is reduced by percutaneous closure of a patent foramen ovale (PFO) in comparison to medical therapy alone. We aimed to review the studies on the cost-effectiveness of percutaneous closure of a PFO in comparison to medical therapy in the prevention of cryptogenic strokes in patients with a PFO. METHODS: This systematic review searched PubMed, EMBASE, Web of Science, Cochrane, and Scopus from 1990 to 2025. RESULTS: Twelve articles qualified for inclusion. The quality of life gained from closing the PFO varied between 3. 25 and 4. 55 among countries. Additionally, the results for the incremental cost-effectiveness ratio per year of life gained were reported to be between 3, 882. 54 and 248, 590. Based on the available evidence, the percutaneous closure of the PFO was found to be cost-effective in preventing a cryptogenic stroke in patients with a PFO in most countries, with the exception of Argentina, compared to medical therapy. CONCLUSIONS: On the basis of the results of the present study, percutaneous closure of the PFO was cost-effective compared to medical therapy in preventing a cryptogenic stroke in patients with a PFO. A majority of studies were conducted in countries with high incomes. Further studies on the cost-effectiveness of percutaneous closure of the PFO are required in low- and middle-income countries. REGISTRATION: : PROSPERO (CRD42024544835).