Left atrial appendage closure with Watchman was cost-saving relative to warfarin (JPY 1,878,335 saved) and DOACs (JPY 1,198,096 saved) and provided 1.500 and 0.996 more QALYs, respectively.
Does left atrial appendage closure with the Watchman device improve cost-effectiveness and quality-adjusted life years compared to warfarin and DOACs in 70-year-old patients with non-valvular atrial fibrillation in Japan?
Left atrial appendage closure with the Watchman device is a cost-saving and quality-of-life improving strategy compared to warfarin and DOACs for stroke prophylaxis in Japanese patients with non-valvular atrial fibrillation.
AIMS: Left atrial appendage closure (LAAC) has been demonstrated to be cost-saving relative to oral anticoagulants for stroke prophylaxis in patients with non-valvular atrial fibrillation (NVAF) in the United States and Europe. This study assessed the cost-effectiveness of LAAC with the Watchman device relative to warfarin and direct oral anticoagulants (DOACs) for stroke risk reduction in NVAF from a Japanese public healthcare payer perspective. METHODS: A Markov model was developed with 70-year-old patients using a lifetime time horizon. LAAC clinical inputs were from pooled, 5-year PROTECT AF and PREVAIL trials; warfarin and DOAC inputs were from published meta-analyses. Baseline stroke and bleeding risks were from the SALUTE trial on LAAC. Cost inputs were from the Japanese Medical Data Vision database. Probabilistic and one-way sensitivity analyses were performed. RESULTS: Over the lifetime time horizon, LAAC was less costly than warfarin (savings of JPY 1, 878, 335, equivalent to US 17, 600) and DOACs (savings of JPY 1, 198, 096, equivalent to US 11, 226). LAAC also provided 1. 500 more incremental quality-adjusted life years (QALYs) than warfarin and 0. 996 more than DOACs. In probabilistic sensitivity analysis, LAAC was cost-effective relative to warfarin and DOACs in 99. 98% and 99. 73% of simulations, respectively. LAAC dominated (had higher cumulative QALYs and was less costly than) warfarin and DOACs in 89. 94% and 83. 35% of simulations, respectively. CONCLUSIONS: Over a lifetime time horizon, LAAC is cost-saving relative to warfarin and DOACs for stroke risk reduction in NVAF patients in Japan and is associated with improved quality-of-life.
Kamae et al. (Wed,) conducted a other in non-valvular atrial fibrillation. Left atrial appendage closure (LAAC) with Watchman vs. warfarin and direct oral anticoagulants (DOACs) was evaluated on Cost-effectiveness (costs and quality-adjusted life years). Left atrial appendage closure with Watchman was cost-saving relative to warfarin (JPY 1,878,335 saved) and DOACs (JPY 1,198,096 saved) and provided 1.500 and 0.996 more QALYs, respectively.