Abstract 16076: Cost-effectiveness of Percutaneous Closure of the Left Atrial Appendage in Atrial Fibrillation Based on Results From PROTECT AF vs. PREVAIL
Introduction: Randomized trials of left atrial appendage (LAA) closure with the Watchman device have shown disparate results, and its cost-effectiveness compared to anticoagulation has not been evaluated using contemporary data.
Methods: We used a Markov decision model to estimate lifetime quality-adjusted survival, costs, and cost-effectiveness of LAA closure with Watchman, compared directly with warfarin and indirectly with dabigatran, using data from the long-term (mean 3.8 year) follow-up of PROTECT AF and PREVAIL randomized trials.
Results: Using data from PROTECT AF, the incremental cost-effectiveness ratios (ICER) compared to warfarin and dabigatran were $20,140 and $24,400 per quality adjusted life year (QALY), respectively. Using data from PREVAIL, LAA closure was dominated by warfarin and dabigatran, meaning that it was less effective (9.46, 9.59, and 9.64 QALYs, respectively) and more costly. At a willingness-to-pay-threshold of $50,000 per QALY, LAA closure was cost-effective 62% and 35% of the time under PROTECT AF and PREVAIL assumptions, respectively. These results were sensitive to the rates of ischemic stroke and intracranial hemorrhage for LAA closure and medical anticoagulation.
Conclusion: The cost-effectiveness of LAA closure with the Watchman device depends largely on the clinical trial used for assigning event rates. Using data from PROTECT AF, Watchman was cost-effective; using PREVAIL data, Watchman was more costly and less effective than warfarin and dabigatran. Results were highly sensitive to the rates of stroke and intracranial hemorrhage in both treatment groups. Post-marketing surveillance of major adverse events will be vital to determining the value of the Watchman in clinical practice.
Author Disclosures: J.V. Freeman: Consultant/Advisory Board; Modest; Janssen Scientific. D.W. Hutton: None. G.D. Barnes: Research Grant; Significant; Blue Cross-Blue Shield of Michigan/Blue Care Network; BSM/Pfizer. Consultant/Advisory Board; Modest; Portola. R.P. Zhu: None. D.K. Owens: None. A.M. Garber: None. A.S. Go: Research Grant; Significant; iRhythm. M.A. Hlatky: Consultant/Advisory Board; Significant; Acumen, Inc; Medical Advisory Panel, Technology Evaluation Center, Blue Cross Blue Shield Association. P.A. Heidenreich: None. P.J. Wang: Research Grant; Modest; Medtronic. Honoraria; Modest; Medtronic, Janssen. A. Al-Ahmad: None. M.P. Turakhia: Employment; Significant; Veterans Affairs. Research Grant; Significant; VA, AHA, Gilead, St Jude Medical, SentreHeart, Medtronic, iRhythm. Other Research Support; Significant; Jannsen, Boehringer-Ingelheim. Honoraria; Significant; Medtronic, St Jude, Biotronik. Ownership Interest; Significant; thryva, Zipline, Cyberheart, Metrica Health. Consultant/Advisory Board; Significant; St Jude Medical, Medtronic, Precision Health Economics.
- © 2015 by American Heart Association, Inc.