Table 2 Summary of results and conclusions of included model-based economic evaluations presented in primary research papers included in this review
Author and year | Mean effect LAAC | Mean cost of LAAC | Mean effect OAC | Mean cost OAC | ICER per QALYf | WTP threshold | Reported probability of the intervention being cost-effective e | Conclusion stated by authors |
|---|---|---|---|---|---|---|---|---|
Warfarin (n = 9) | ||||||||
 Reddy et al. 2019 | 7.77 | USD 44 894 | 7.17 | USD 61 623 | USD 48 674c USD 35 051d | USD 50 000 | LAAC—98%a | LAAC is cost-effective and cost saving relative to NOAC and warfarin |
 Reddy et al. 2018 | 6.09 | USD 55 749 | 5.66 | USD 85 577 | Dominant (value not presented) | USD 50 000 | LAAC–100%a | LAAC is the most cost-effective treatment strategy for secondary prevention of stroke in atrial fibrillation |
 Ontario HTA | 5.66 | CAD 40 707 | 5.60 | CAD 24 374 | CAD 272 216 | CAD 100 000 | LAAC—4% Warfarin–0% | LAAC device has higher costs and lower QALYs compared with apixaban, dabigatran and rivaroxaban in patients with nonvalvular AF and no contraindication to OAC |
 Freeman et al. 2016 (Protect-AF data) | 9.94 | USD 132 844 | 7.96 | USD 92 190 | USD 20 486 | USD 50 000 | LAAC ~ 90%b | The cost effectiveness of LAA closure using PROTECT AF data was in a range generally considered to be cost effective. Using data from PREVAIL, however, LAA closure was dominated by warfarin and dabigatran |
 Freeman et al. 2016 (Prevail data) | 8.44 | USD 120 977 | 8.54 | USD 73 077 | Dominated (value not presented) | USD 50 000 | Warfarin ~ 78%b LAAC–9% | |
 Lee et al. 2016 | 10.99 | USD 37 789 | 9.45 | USD 28,090 | USD 6 298 | USD 50 000 | LAAC–86%a | LAAO was cost-effective compared to all tested OAC |
 Micieli et al. 2016 | 5.21 | CAD 21 789 | 5.13 | CAD 15 776 | Considered warfarin as the reference | CAD 50 000 | LAAC ~ 30%b Warfarin ~ 12% | Apixaban is the preferred long-term strategy |
 Reddy et al. 2015 | 8.03 | USD 31 198 | 7.39 | USD 49 946 | USD 42 994 | USD 50 000 | LAAC–98%a | Both NOAC and LAAC with the Watchman device were cost-effective relative to warfarin, but LAAC was also found to be cost-effective and to offer better value relative to NOAC |
 Singh et al. 2013 | 4.68 | CAD 27 003 | 4.55 | CAD 21 429 | CAD 41 565 | CAD 50 000 | Warfarin ~ 44% LAAC ~ 43%b | LAAC is cost-effective compared with warfarin therapy |
Novel OAC as a class (n = 4) | ||||||||
 Labori et al. 2022 | 7.11 | Healthcare perspective: € 19 032 Public sector perspective: € 21 029 | 6.12 | Healthcare perspective: € 15 022 Public sector perspective: € 31 281 | Healthcare perspective: € 4047 Public sector perspective: LAAC is dominant | Euro 45 829 | Healthcare perspective: % Not specified Public sector perspective: LAAC—99% | LAAC is cost-effective than OAC from both healthcare and public sector perspective |
 Kawakami et al. 2020 | 6.13 | USD 29 027 | 6.03 | USD 27 896 | USD 11 072 | USD 50 000 | (LAAC + CA) > 70%a | Combined CA and LAAC procedure may be a cost-effective therapeutic option |
 Reddy et al. 2019 | 7.77 | USD 44 894 | 7.48 | USD 77 023 | Dominant (value not presented) | USD 50 000 | LAAC–95%a | LAAC is cost-effective and cost saving relative to NOAC and warfarin |
 Reddy et al. 2015 | 8.03 | USD 31 198 | 7.68 | USD 61 701 | USD 48 446 relative to warfarin | USD 50 000 | LAAC–95%a | Both NOAC and LAAC with the Watchman device were cost-effective relative to warfarin, but LAAC was also found to be cost-effective and to offer better value relative to NOAC |
Dabigatran (n = 8) | ||||||||
 Reddy et al. 2018 | 6.09 | USD 55 749 | 5.84 | USD 87636 | Dominant (value not presented) | USD 50 000 | LAAC–90%a | LAAC is the most cost-effective treatment strategy for secondary prevention of stroke in atrial fibrillation |
 Ontario HTA | 5.66 | CAD 40 707 | 5.81 | CAD 25 694 | Dominated (value not presented) | CAD 100 000 | Dabigatran–47% LAAC–4% | LAAC device has higher costs and lower QALYs compared with apixaban, dabigatran and rivaroxaban in patients with nonvalvular AF and no contraindication to OAC |
 Lee et al. 2016 (Dabigatran 110 mg) | 10.99 | USD 37 789 | 8.76 | USD 42 712 | Dominated (value not presented) | USD 50 000 | LAAC—86%a | LAAO was cost-effective compared to all tested OAC |
 Lee et al. 2016 (Dabigatran 150 mg) | 10.99 | USD 37 789 | 9.00 | USD 43 946 | Dominated (value not presented) | USD 50 000 | LAAC–86%a | LAAO was cost-effective compared to all tested OAC |
 Freeman et al. 2016 (Protect-AF data) | 9.94 | USD 132 844 | 8.28 | USD 94 072 | USD 23 422 | USD 50 000 | LAAC ~ 90%b | The cost effectiveness of LAA closure using PROTECT AF data was in a range generally considered to be cost effective. Using data from PREVAIL, however, LAA closure was dominated by warfarin and dabigatran |
 Freeman et al. 2016 (Prevail data) | 8.44 | USD 120 977 | 8.59 | USD 83 746 | Dominated (value not presented) | USD 50 000 | Dabigatran ~ 11%b LAAC–9% | |
 Micieli et al. 2016 | 5.21 | CAD 21 789 | 5.18 | CAD 20 794 | Dominated (value not presented) | CAD 50 000 | LAAC ~ 30%b Dabigatran–0% | Apixaban is the preferred long-term strategy |
 Singh et al. 2013 | 4.68 | CAD 27 003 | 4.64 | CAD 25 760 | CAD 46 560 compared to warfarin | CAD 50 000 | LAAC ~ 43%b Dabigatran ~ 10% | LAAC is cost-effective compared with warfarin therapy |
Apixaban (n = 5) | ||||||||
 Reddy et al. 2018 | 6.09 | USD 55749 | 5.82 | USD 85426 | Dominant (value not presented) | USD 50 000 | LAAC–95%a | LAAC is the most cost-effective treatment strategy for secondary prevention of stroke in atrial fibrillation |
 Ontario HTA | 5.66 | CAD 40 707 | 5.82 | Dominated (value not presented) | USD -80 758 | CAD100 000 | Apixaban–48% LAAC–4% | LAAC device has higher costs and lower QALYs compared with apixaban, dabigatran and rivaroxaban in patients with nonvalvular AF and no contraindication to OAC |
 Micieli et al. 2016 | 5.21 | CAD 21 789 | 5.25 | CAD 19 156 | CAD 28 167 compared to warfarin | CAD 50 000 | Apixaban–40%a LAAC ~ 30% | Apixaban is the preferred long-term strategy |
 Reddy et al. 2016 | 4.82 | € 15 837 | 4.59 | € 18 869 | € 9040 | € 30 000 | LAAC–94%a | LAAC with the Watchman device is a cost-effective and cost-saving solution |
 Lee et al. 2016 | 10.99 | USD 37 789 | 9.40 | USD 53 315 | Dominated (less costly, more effective) | USD 50 000 | LAAC–86%a | LAAO was cost-effective compared to all tested OAC |
Rivaroxaban (n = 3) | ||||||||
 Ontario HTA | 5.66 | CAD 40 707 | 5.74 | CAD 30 530 | Dominated (value not presented) | CAD 100 000 | Rivaroxaban–1% LAAC–4% | LAAC device has higher costs and lower QALYs compared with apixaban, dabigatran and rivaroxaban in patients with nonvalvular AF and no contraindication to OAC |
 Lee et al. 2016 | 10.99 | USD 37 789 | 9.86 | USD 51 064 | Dominated (less costly, more effective) | USD 50 000 | LAAC–86%a | LAAO was cost-effective compared to all tested OAC |
 Micieli et al. 2016 | 5.21 | CAD 21 789 | 5.21 | CAD 18 280 | CAD 31 300 compared to warfarin | CAD 50 000 | Rivaroxaban ~ 12% LAAC ~ 30%b | Apixaban is the preferred long-term strategy |