Clinical InvestigationCost-effectiveness of combined catheter ablation and left atrial appendage closure for symptomatic atrial fibrillation in patients with high stroke and bleeding risk
Section snippets
Decision model
Our base case consisted of a hypothetical cohort of patients aged 65 years with symptomatic AF planned for AF ablation, a CHA2DS2-VASc score of 3, and high bleeding risk (HAS-BLED score of 3) but without contraindications to OAC therapy. A simplified presentation of the model structure and patient pathway is depicted in Figure 1. The post-AF ablation strategies were as follows:
- 1.
Standard OAC strategy: the standard OAC therapy with nonwarfarin oral anticoagulants (NOACs) (dabigatran, rivaroxaban,
Base-case analysis
In the base-case cohort of 10,000 patients followed for 10 years, total costs for the LAAC strategy were US $29,027 and for OAC strategy were US $27,896 (Table II). The LAAC strategy was associated with 122 fewer disabling strokes per 10,000 patients and 203 fewer ICH per 10,000 patients compared with the OAC strategy (Table III). Thus, the LAAC strategy was more effective but with higher total costs, which resulted in an ICER of US $11,072/QALY. High upfront costs for the combined LAAC
Discussion
This analysis suggests that the combined CA and LAAC are a cost-effective therapeutic option for long-term stroke prevention in symptomatic AF patients planned for AF ablation with high stroke and bleeding risk (CHA2DS2-VASc score of 3 and HAS-BLED score of 3). Although deterministic sensitivity analysis demonstrated that cost-effectiveness was highly dependent on the LAAC relative risk of ICH and cost for combined procedure, the LAAC strategy was more cost-effective relative to the OAC
Conclusions
In symptomatic AF patients with high stroke and bleeding risk who are planned for CA, the combined CA and LAAC procedure may be a cost-effective therapeutic option, with more benefit to patients with CHA2DS2-VASc risk score ≥3.
Disclosures
K. P. has received fees for clinical proctorship, presentations, and advisory board participation from Boston Scientific, Medtronic, and Abbott.
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Cited by (11)
Actual management costs of patients with non-valvular atrial fibrillation treated with percutaneous left atrial appendage closure or oral anticoagulation
2022, International Journal of CardiologyCitation Excerpt :Finally, because from our matched study it emerges that management costs of patients on OAC are significantly higher than management costs of patients after percutaneous LAAC, further investigations are necessary to clarify the potential net economic and clinical benefit that percutaneous LAAC could achieve in patients that are now treated with OAC only, according to international guidelines [3,4]. Future studies are also necessary to confirm (or refute) that, compared to OAC therapy, percutaneous LAAC is more cost effective, particularly in patients with higher risk for stroke [20]. To conclude, in our case-match study, percutaneous LAAC is an independent determinant to significantly reduce management costs of patients with non-valvular AF.
Cost-effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation: a systematic review appraising the methodological quality
2023, Cost Effectiveness and Resource AllocationPercutaneous Left Atrial Appendage Occlusion Therapy: Evolution and Growing Evidence
2023, Reviews in Cardiovascular Medicine
Funding sources: none.