| アブストラクト | AIMS: Left atrial appendage closure (LAAC) has been demonstrated to be cost-saving relative to oral anticoagulants for stroke prophylaxis in patients with non-valvular atrial fibrillation (NVAF) in the United States and Europe. This study assessed the cost-effectiveness of LAAC with the Watchman device relative to warfarin and direct oral anticoagulants (DOACs) for stroke risk reduction in NVAF from a Japanese public healthcare payer perspective. METHODS: A Markov model was developed with 70-year-old patients using a lifetime time horizon. LAAC clinical inputs were from pooled, 5-year PROTECT AF and PREVAIL trials; warfarin and DOAC inputs were from published meta-analyses. Baseline stroke and bleeding risks were from the SALUTE trial on LAAC. Cost inputs were from the Japanese Medical Data Vision database. Probabilistic and one-way sensitivity analyses were performed. RESULTS: Over the lifetime time horizon, LAAC was less costly than warfarin (savings of JPY 1,878,335, equivalent to US $17,600) and DOACs (savings of JPY 1,198,096, equivalent to US $11,226). LAAC also provided 1.500 more incremental quality-adjusted life years (QALYs) than warfarin and 0.996 more than DOACs. In probabilistic sensitivity analysis, LAAC was cost-effective relative to warfarin and DOACs in 99.98% and 99.73% of simulations, respectively. LAAC dominated (had higher cumulative QALYs and was less costly than) warfarin and DOACs in 89.94% and 83.35% of simulations, respectively. CONCLUSIONS: Over a lifetime time horizon, LAAC is cost-saving relative to warfarin and DOACs for stroke risk reduction in NVAF patients in Japan and is associated with improved quality-of-life. |
|---|
| 投稿者 | Kamae, Isao; Zhong, Yue; Hara, Hidehiko; Inoue, Koichi; Yasaka, Masahiro; Reddy, Vivek Y; Holmes, David R; Sakurai, Masaya; Gavaghan, Meghan B; Amorosi, Stacey L; McGovern, Alysha M; Priest, Virginia; Inoue, Sachie; Shibahara, Hidetoshi; Akehurst, Ronald L |
|---|
| 組織名 | Graduate School of Public Policy, University of Tokyo, Tokyo, Japan.;Heath Economics and Market Access, Boston Scientific, Marlborough, MA, USA.;Division of Cardiovascular Medicine, Toho University Ohashi Medical Center,;Tokyo, Japan.;Cardiovascular Division, National Hospital Organization Osaka National Hospital,;Osaka, Japan.;Department of Cerebrovascular Medicine and Neurology, National Hospital;Organization Kyushu Medical Center, Fukuoka, Japan.;Icahn School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY,;USA.;Mayo Clinic, Rochester, MN, USA.;Health Economics, Boston Scientific Japan, Tokyo, Japan.;Market Access, Ipsos Healthcare, New York, NY, USA.;Health Economics and Market Access, Boston Scientific Asia Pacific, Singapore.;CRECON Medical Assessment, Tokyo, Japan.;BresMed Health Solutions, Sheffield, UK.;University of Sheffield, Sheffield, UK. |
|---|
