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

A patent foramen ovale (PFO) closure reduces the risk of recurrent cryptogenic ischemic strokes in young to middle-aged patients. 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. This systematic review searched PubMed, EMBASE, Web of Science, Cochrane, and Scopus from 1990 to 2025. Twelve articles qualified for inclusion. Closed PFOs resulted in a quality-of-life gain of 3.25 to 4.55 years for most countries. According to the study, the incremental cost-effectiveness ratio per year of life gained was between $3,882.54 and $248,590. Percutaneous closure of the PFO has been found to be cost-effective compared to medical therapy in most countries, with the exception of Argentina. 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. PROSPERO (CRD42024544835).