Left atrial appendage closure was dominant over warfarin and NOACs at 10 years, yielding more quality-adjusted life years (4.986) and lower costs ($42,616) for secondary stroke prevention.
Is left atrial appendage closure cost-effective compared with warfarin or non-vitamin K antagonist oral anticoagulants for secondary prevention of stroke in patients with nonvalvular atrial fibrillation?
Left atrial appendage closure is a cost-effective, dominant strategy over 10 years and lifetime compared to warfarin and NOACs for secondary stroke prevention in nonvalvular atrial fibrillation.
BACKGROUND AND PURPOSE: Once a patient with atrial fibrillation experiences an embolic event, the risk of a recurrent event increases 2. 6-fold. New treatments have emerged as viable treatment alternatives to warfarin for stroke risk reduction in secondary prevention populations. This analysis sought to assess the cost-effectiveness of left atrial appendage closure (LAAC) compared with warfarin and the non-vitamin K antagonist oral anticoagulants dabigatran 150 mg, apixaban and rivaroxaban in the prevention of stroke in nonvalvular atrial fibrillation patients with a prior stroke or transient ischemic attack. METHODS: -VASc score of 7 (annual stroke risk=9. 60%) and HAS-BLED score of 3 (annual bleeding risk=3. 74%). RESULTS: LAAC achieved cost-effectiveness relative to dabigatran at year 5 and warfarin and apixaban at year 6. At 10 years, LAAC had more quality-adjusted life years (4. 986 versus 4. 769, 4. 869, 4. 888, and 4. 810) and lower costs (42 616 versus 53 770, 58 774, 55 656, and 58 655) than warfarin, dabigatran, apixaban, and rivaroxaban, respectively, making LAAC the dominant (more effective and less costly) stroke risk reduction strategy. LAAC remained the dominant strategy over the lifetime analysis. CONCLUSIONS: Upfront procedure costs initially make LAAC higher cost than warfarin and the non-vitamin K antagonist oral anticoagulants, but within 10 years, LAAC delivers more quality-adjusted life years and has lower total costs, making LAAC the most cost-effective treatment strategy for secondary prevention of stroke in atrial fibrillation.
Reddy et al. (Tue,) conducted a other in Nonvalvular atrial fibrillation with prior stroke or transient ischemic attack. Left atrial appendage closure (WATCHMAN) vs. Warfarin, dabigatran 150 mg, apixaban, and rivaroxaban was evaluated on Cost-effectiveness (Quality-adjusted life years and total costs). Left atrial appendage closure was dominant over warfarin and NOACs at 10 years, yielding more quality-adjusted life years (4.986) and lower costs ($42,616) for secondary stroke prevention.
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