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Researchers have compared the cost-effectiveness of left atrial appendage closure (LAAC) with the Watchman device to treatment with warfarin or novel oral anticoagulants (NOACs) as stroke prophylaxis in patients with non-valvular atrial fibrillation.
The results showed that, in the long-term, both NOACs and LAAC were cost-effective relative to warfarin.
LAAC was cost-saving relative to warfarin by year 10 and relative to NOACs by year 5. NOACs were not cost-saving relative to warfarin over the 20-year period studied.
Vivek Reddy, MD, of the Mount Sinai Medical Center in New York, New York, and his colleagues reported these findings in the Journal of American College of Cardiology.
The researchers used a Markov model to evaluate the cost-effectiveness of warfarin, NOACs, and LAAC with the Watchman device from the perspective of the Centers for Medicare & Medicaid Services over a lifetime horizon, which was defined as 20 years.
The patients were 70 years of age and at moderate risk for stroke and bleeding. Clinical event rates, stroke outcomes, and quality of life information were drawn predominantly from 4-year data from the PROTECT AF trial and meta-analyses of warfarin and NOACs.
Costs were presented in 2015 US dollars. The researchers assessed cost-effectiveness annually to determine if there was an observable time horizon over which treatment options reached accepted levels of cost-effectiveness.
They found that LAAC was more expensive than warfarin in the first post-procedure year, and patients had fewer quality-adjusted life years (QALYs) with LAAC.
But by year 3, LAAC-treated patients had gained more QALYs than warfarin-treated patients. And LAAC became cost-effective relative to warfarin by year 7, with a cost per QALY gained of $42,994.
By year 10, LAAC was more effective and less costly than warfarin. This was true for the remainder of the 20-year time horizon. Over a lifetime, LAAC provided an additional 0.506 life-years and 0.638 QALYs relative to warfarin.
NOACs were more effective than warfarin in year 1 and achieved cost-effectiveness relative to warfarin at year 16, with a cost per QALY gained of $48,446.
NOACs were not cost-saving relative to warfarin over 20 years. However, the incremental cost-effectiveness ratio continued to decrease over time so the cost per QALY gained at 20 years was $40,602.
Compared to NOACs, LAAC was more expensive in the first year post-procedure. However, by year 5, LAAC was less expensive—$20,892 vs $20,924—and more effective—3.455 QALYs vs 3.448 QALYs. This remained true for the rest of the time horizon.
Over a patient’s lifetime, LAAC was estimated to provide an additional 0.298 life-years and 0.349 QALYs relative to NOACs.
Dr Reddy and other authors of this paper are paid consultants to Boston Scientific, manufacturer of the Watchman device. Another author is a full-time employee of Boston Scientific, and yet another author has a financial interest in the Watchman device. Dr Reddy is also a paid consultant for and has received grant support from Coherex and St. Jude Medical. 
Photo courtesy of
Boston Scientific
Researchers have compared the cost-effectiveness of left atrial appendage closure (LAAC) with the Watchman device to treatment with warfarin or novel oral anticoagulants (NOACs) as stroke prophylaxis in patients with non-valvular atrial fibrillation.
The results showed that, in the long-term, both NOACs and LAAC were cost-effective relative to warfarin.
LAAC was cost-saving relative to warfarin by year 10 and relative to NOACs by year 5. NOACs were not cost-saving relative to warfarin over the 20-year period studied.
Vivek Reddy, MD, of the Mount Sinai Medical Center in New York, New York, and his colleagues reported these findings in the Journal of American College of Cardiology.
The researchers used a Markov model to evaluate the cost-effectiveness of warfarin, NOACs, and LAAC with the Watchman device from the perspective of the Centers for Medicare & Medicaid Services over a lifetime horizon, which was defined as 20 years.
The patients were 70 years of age and at moderate risk for stroke and bleeding. Clinical event rates, stroke outcomes, and quality of life information were drawn predominantly from 4-year data from the PROTECT AF trial and meta-analyses of warfarin and NOACs.
Costs were presented in 2015 US dollars. The researchers assessed cost-effectiveness annually to determine if there was an observable time horizon over which treatment options reached accepted levels of cost-effectiveness.
They found that LAAC was more expensive than warfarin in the first post-procedure year, and patients had fewer quality-adjusted life years (QALYs) with LAAC.
But by year 3, LAAC-treated patients had gained more QALYs than warfarin-treated patients. And LAAC became cost-effective relative to warfarin by year 7, with a cost per QALY gained of $42,994.
By year 10, LAAC was more effective and less costly than warfarin. This was true for the remainder of the 20-year time horizon. Over a lifetime, LAAC provided an additional 0.506 life-years and 0.638 QALYs relative to warfarin.
NOACs were more effective than warfarin in year 1 and achieved cost-effectiveness relative to warfarin at year 16, with a cost per QALY gained of $48,446.
NOACs were not cost-saving relative to warfarin over 20 years. However, the incremental cost-effectiveness ratio continued to decrease over time so the cost per QALY gained at 20 years was $40,602.
Compared to NOACs, LAAC was more expensive in the first year post-procedure. However, by year 5, LAAC was less expensive—$20,892 vs $20,924—and more effective—3.455 QALYs vs 3.448 QALYs. This remained true for the rest of the time horizon.
Over a patient’s lifetime, LAAC was estimated to provide an additional 0.298 life-years and 0.349 QALYs relative to NOACs.
Dr Reddy and other authors of this paper are paid consultants to Boston Scientific, manufacturer of the Watchman device. Another author is a full-time employee of Boston Scientific, and yet another author has a financial interest in the Watchman device. Dr Reddy is also a paid consultant for and has received grant support from Coherex and St. Jude Medical.
Photo courtesy of
Boston Scientific
Researchers have compared the cost-effectiveness of left atrial appendage closure (LAAC) with the Watchman device to treatment with warfarin or novel oral anticoagulants (NOACs) as stroke prophylaxis in patients with non-valvular atrial fibrillation.
The results showed that, in the long-term, both NOACs and LAAC were cost-effective relative to warfarin.
LAAC was cost-saving relative to warfarin by year 10 and relative to NOACs by year 5. NOACs were not cost-saving relative to warfarin over the 20-year period studied.
Vivek Reddy, MD, of the Mount Sinai Medical Center in New York, New York, and his colleagues reported these findings in the Journal of American College of Cardiology.
The researchers used a Markov model to evaluate the cost-effectiveness of warfarin, NOACs, and LAAC with the Watchman device from the perspective of the Centers for Medicare & Medicaid Services over a lifetime horizon, which was defined as 20 years.
The patients were 70 years of age and at moderate risk for stroke and bleeding. Clinical event rates, stroke outcomes, and quality of life information were drawn predominantly from 4-year data from the PROTECT AF trial and meta-analyses of warfarin and NOACs.
Costs were presented in 2015 US dollars. The researchers assessed cost-effectiveness annually to determine if there was an observable time horizon over which treatment options reached accepted levels of cost-effectiveness.
They found that LAAC was more expensive than warfarin in the first post-procedure year, and patients had fewer quality-adjusted life years (QALYs) with LAAC.
But by year 3, LAAC-treated patients had gained more QALYs than warfarin-treated patients. And LAAC became cost-effective relative to warfarin by year 7, with a cost per QALY gained of $42,994.
By year 10, LAAC was more effective and less costly than warfarin. This was true for the remainder of the 20-year time horizon. Over a lifetime, LAAC provided an additional 0.506 life-years and 0.638 QALYs relative to warfarin.
NOACs were more effective than warfarin in year 1 and achieved cost-effectiveness relative to warfarin at year 16, with a cost per QALY gained of $48,446.
NOACs were not cost-saving relative to warfarin over 20 years. However, the incremental cost-effectiveness ratio continued to decrease over time so the cost per QALY gained at 20 years was $40,602.
Compared to NOACs, LAAC was more expensive in the first year post-procedure. However, by year 5, LAAC was less expensive—$20,892 vs $20,924—and more effective—3.455 QALYs vs 3.448 QALYs. This remained true for the rest of the time horizon.
Over a patient’s lifetime, LAAC was estimated to provide an additional 0.298 life-years and 0.349 QALYs relative to NOACs.
Dr Reddy and other authors of this paper are paid consultants to Boston Scientific, manufacturer of the Watchman device. Another author is a full-time employee of Boston Scientific, and yet another author has a financial interest in the Watchman device. Dr Reddy is also a paid consultant for and has received grant support from Coherex and St. Jude Medical.