45 * Real world experience left atrial appendage closure provides superior cost benefits relative to new and established oral anticoagulants

Abstract

Introduction: Recent evidence supports left atrial appendage closure (LAAC) as a cost-effective alternative to warfarin. However these findings, based on clinical trial populations, may not be generalisable to clinical practice. The cost-impact of a real world experience of LAAC compared with warfarin, dabigatran, rivaroxaban, apixaban, aspirin and no therapy in patients with nonvalvular atrial fibrillation (NVAF) is unknown. Methods: Cost minimisation analysis using a cost impact model incorporating data from a network metaanalysis was used to systematically assess the costs of LAAC device implantation over a 10 year time horizon to determine the costs of LAAC in relation to all other treatment strategies in patients with nonvalvular AF at risk of stroke, with and without contraindications to anticoagulation. Complications and subsequent stroke rates were determined from our experience of 112 implants in 110 patients (Age 70.8±9.7, CHA2DS2-VASc 4.6±1.7, HAS-BLED 3.9±1.2). Device implantation and complication costs were obtained from UK NHS 2014 tariffs, while those for stroke were sourced from peer-reviewed literature. Overall cost-impact of LAAC was quantified as time to achieve cost parity with other strategies and cost saved over 10 years. Results: Cost parity was achieved between 4.8 (vs Dabigatran 110mg) to 7.3 (vs Warfarin) years. Cost saving over 10 years ranged between 26.4% against PROTECT AF data (£9,933.82 vs £13,504.16) and 46.7% against Dabigatran 110mg (£9,933.82 vs £18,633.71). Conclusion: LAAC in real world practice can substantially reduce costs relative to all other treatment strategies, including clinical trial data of LAAC, over a relatively short time horizon for patients at risk with NVAF. (Table Presented).