Abstract 17478: Cost Effectiveness of Left Atrial Appendage Closure in Atrial Fibrillation Patients With Previous Stroke or Transient Ischemic Attack
Purpose: Once a patient with atrial fibrillation (AF) experiences an embolic event the probability of a second event increases 2.6 fold. The WATCHMAN device for left atrial appendage closure (LAAC) is indicated for stroke prevention in AF. This analysis sought to estimate the cost effectiveness of LAAC versus warfarin for the prevention of recurrent stroke in AF.
Methods: A Markov model was developed comparing clinical outcomes and total costs for patients with a previous stroke or TIA treated with either LAAC or warfarin. Clinical data were taken from PROTECT-AF which treated 131 patients with a history of stroke and a mean CHADS2 score of 3.9 with either LAAC or warfarin. Rates of intracranial hemorrhage for warfarin and aspirin came from European AF Trial and other studies of secondary prevention.
The model was populated with 10,000 patients aged 70 years with a mean CHADS2 score of 4. Sensitivity analyses were conducted on clinical variables, with the model being most sensitive to the rate of stroke. Germany was the country of analysis because of its unique DRG for LAAC. Acute costs were taken from German DRGs and long-term disability costs from the Berlin Acute Stroke Study.
Results: LAAC demonstrated a lower rate of stroke over time, preventing 183 recurrent strokes at 5 years and 1,030 at 10 years. A similar benefit was seen with mortality, with 162 deaths avoided at 5 years and 303 at 10 years with LAAC compared to warfarin.
The cost per composite efficacy endpoint avoided was є98,866 at 5 years. LAAC was dominant (less expensive and more effective) over warfarin by 9 years with a mean cost per patient of є20,227 versus є20,604.
Conclusion: LAAC is a cost-effective alternative to warfarin in AF patients with a history of stroke. As a device-based treatment, the costs of LAAC are almost entirely procedure based, whereas the treatment and complication costs of warfarin accrue year on year. This analysis highlights the importance of considering the lifetime costs of stroke prevention in AF.
- © 2013 by American Heart Association, Inc.