Positive cost effectiveness study of WATCHMAN LAAC for stroke reduction- Boston Scientific

The WATCHMAN Left Atrial Appendage Closure Device is more cost-effective than warfarin and non-warfarin oral anticoagulants (NOACs) for stroke reduction in patients with non-valvular atrial fibrillation, according to a study led by Vivek Reddy, MD, Director of Cardiac Arrhythmia Services for The Mount Sinai Hospital and the Mount Sinai Health System, and published online and in the December 22 issue of the Journal of American College of Cardiology(JACC).

Blood-thinning medications like warfarin and NOACs have long been the standard of care for reducing the risk for stroke in patients with atrial fibrillation; however, many patients cannot tolerate these medications because of the incidence of bleeding and need for bi-weekly blood tests. While these therapies have been demonstrated to be efficacious, their effectiveness is contingent upon patient adherence, as gaps in treatment can lead to stroke.

Researchers used a Markov model constructed from the perspective of the Centers for Medicare & Medicaid Services (CMS) with a lifetime horizon defined as 20 years and 3-month cycle length to evaluate the cost effectiveness of the three treatment strategies. Cost effectiveness was assessed annually to determine if there was an observable time horizon over which treatment options reached accepted levels of cost effectiveness. The researchers found: 1.The WATCHMAN device achieved cost effectiveness relative to warfarin at seven years ($42,994/QALY) and NOACs achieved cost effectiveness relative to warfarin at 16 years ($48,446/QALY) when assessing Medicare beneficiaries over a 20-year period. 2.The WATCHMAN device became dominant (more effective and less costly) to warfarin at 10 years and dominant to NOACs at five years, with cost savings generated annually thereafter.

Comment: An attraction of WATCHMAN is that it eliminates the problem of non compliance and non adherence that affects medications . Once WATCHMAN is implanted it provides life long stroke prophylaxis without the complications of anti coagulation.