Analysis Supports Cost-Effectiveness of Boston Scientific's Watchman for Stroke Reduction in AF Patients

November 25, 2015—Vivek Y. Reddy, MD, et al published findings from an analysis assessing the cost-effectiveness of warfarin, nonwarfarin oral anticoagulants (NOACs), and left atrial appendage closure (LAAC) with the Watchman device (Boston Scientific Corporation) for stroke risk reduction in patients with nonvalvular atrial fibrillation (AF) at multiple time points over a lifetime horizon. The study is available online ahead of print in Journal of the American College of Cardiology.

The study demonstrated that both NOACs and LAAC with the Watchman device were cost-effective, relative to warfarin, but LAAC was also found to be cost-effective and offers better value relative to NOACs. The results of this analysis should be considered when formulating policy and practice guidelines for stroke prevention in AF, advised the investigators in JACC.

For the analysis, the investigators developed a Markov model to assess the cost-effectiveness of LAAC, NOACs, and warfarin from the perspective of the Centers for Medicare & Medicaid Services over a lifetime (20-year) horizon. Patients were 70-years-of-age and at moderate risk for stroke and bleeding. Clinical event rates, stroke outcomes, and quality-of-life information were drawn predominantly from PROTECT AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients with Atrial Fibrillation) 4-year data and meta-analyses of warfarin and NOACs. Costs for stroke risk reduction therapies, treatment of associated acute events, and long-term care after disabling stroke were presented in 2015 United States dollars.

As summarized in JACC, the investigators found that relative to warfarin, LAAC was cost-effective at 7 years ($42,994/quality-adjusted life-years [QALY]), and NOACs were cost-effective at 16 years ($48,446/QALY). LAAC was dominant over NOACs by year 5 and warfarin by year 10. At 10 years, LAAC provided more QALY than warfarin and NOACs (5.855 vs 5.601 vs 5.751, respectively). In sensitivity analyses, LAAC remained cost-effective relative to warfarin ($41,470/QALY at 11 years) and NOACs ($21,964/QALY at 10 years), even if procedure costs were doubled.