17-05: Health Economic Analysis of Left Atrial Appendage Closure from Randomised Controlled Trial and Real-World Experience Relative to Oral Anticoagulation by CHA2DS2-VASc sub-group

Abstract

Purpose of the study: Recent evidence supports left atrial appendage closure (LAAC) as a cost‐effective alternative to warfarin, though clinical trial evidence may not be generalisable to clinical practice. The cost‐impact of a real‐world experience of LAAC stratified by baseline stroke risk and compared with currently available therapies in patients with nonvalvular atrial fibrillation (NVAF) is unknown. Method used: Registry data of LAAC from two centres were prospectively collected in 110 patients with NVAF at risk of stroke (age 71.3 + 9.2yrs, CHA2DS2‐VASc 4.5 + 1.6, HAS‐BLED 3.8 + 1.1, mean follow‐up 24.1 + 4.6months). Outcomes from PROTECT AF and registry study LAAC were compared with warfarin, dabigatran, rivaroxaban, apixaban, aspirin and no treatment using a network meta‐analysis and stratified by CHA2DS2‐VASc subgroups. Overall cost‐impact of LAAC was quantified as time to achieve cost parity with other strategies and cost saved over 10 years. Summary of results: Cost parity was achieved between 4.7 (vs Dabigatran 110mg) to 8.4 (vs Warfarin) years. Cost saving over 10 years ranged between 11% against warfarin (£1194) and 44% against Dabigatran 110mg (£7676). Sub‐group analysis by CHA2DS2‐VASc score, demonstrated that higher baseline stroke risk, was associated with incrementally shorter times to cost parity and higher cost savings with LAAC. Conclusion: LAAC in both real‐world and clinical trial settings achieves cost‐parity in a relatively short period of time with substantial savings over current therapies. Benefits are most pronounced among higher stroke risk patients. This may help clinicians to tailor stroke prevention therapy to the individual stroke risk of patients (Figure Presented).