Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 463, Gothenburg 405 30, Sweden.
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Blå stråket 7, Gothenburg 413 45, Sweden.
Eur Heart J. 2022 Mar 31;43(13):1348-1356. doi: 10.1093/eurheartj/ehab847.
This study aims to estimate the cost-effectiveness of percutaneous left atrial appendage occlusion (LAAO) compared to standard stroke prevention care for patients with atrial fibrillation (AF) and contraindication to oral anticoagulation (OAC) in a Swedish healthcare and public sector perspective.
We used a combined decision tree and cohort Markov model to estimate costs and quality-adjusted life-years (QALYs) over a lifetime horizon with LAAO compared to standard of care where the treatment effect is based on a recent meta-analysis. According to our analysis, LAAO gives more QALYs than standard of care (7.11 vs. 6.12). Furthermore, LAAO treatment is related to the first-year cost of 14 984 Euro (EUR) and higher average healthcare costs over the lifetime by about 4010 EUR, which gives an incremental cost-effectiveness ratio of LAAO vs. standard of care at 4047 EUR per gained QALY. From a public sector perspective, LAAO reduces average costs due to substantial reductions in long-term care and, thus, implies that LAAO is dominant from a public sector perspective (lower average costs and better health outcomes).
From both Swedish healthcare and public sector perspectives, LAAO can be considered cost-effective compared to standard of care for individuals with AF and contraindication to OAC. However, these results must be confirmed in health economic evaluations alongside the ongoing randomized clinical trials.
Is left atrial appendage occlusion (LAAO) cost-effective for patients with atrial fibrillation (AF) and contraindication to oral anticoagulation (OAC) compared to the standard of care from a Swedish healthcare and public sector perspective?
LAAO is associated with lower cost than the standard of care from a public sector perspective and an incremental cost of 4010 Euro from a healthcare perspective. Furthermore, LAAO is related to better health outcomes than the standard of care.
Treatment with LAAO among individuals with AF and contraindication to OAC can be considered as cost-effective compared to the standard of care from a Swedish healthcare and public sector perspective.
本研究旨在从瑞典医疗保健和公共部门的角度，评估经皮左心耳封堵术（LAAO）与房颤（AF）合并抗凝禁忌的患者的标准卒中预防护理相比的成本效益。
我们使用联合决策树和队列马尔可夫模型，根据最近的荟萃分析，在终生范围内估计 LAAO 与标准护理相比的成本和质量调整生命年（QALY）。根据我们的分析，LAAO 比标准护理提供更多的 QALYs（7.11 对 6.12）。此外，LAAO 治疗与第一年 14984 欧元（EUR）的成本相关，并且在整个生命周期内平均医疗保健成本增加约 4010 欧元，这使得 LAAO 与标准护理相比的增量成本效益比为每获得一个 QALY 为 4047 欧元。从公共部门的角度来看，LAAO 降低了长期护理的平均成本，因此，从公共部门的角度来看，LAAO 是占主导地位的（较低的平均成本和更好的健康结果）。
从瑞典医疗保健和公共部门的角度来看，对于合并 AF 和抗凝禁忌的患者，LAAO 可被认为比标准护理更具成本效益。然而，这些结果必须在与正在进行的随机临床试验一起的健康经济评估中得到确认。
从瑞典医疗保健和公共部门的角度来看，对于合并有抗凝禁忌的房颤患者，左心耳封堵术（LAAO）是否比标准护理更具成本效益？
从公共部门的角度来看，LAAO 的成本低于标准护理，从医疗保健的角度来看，增量成本为 4010 欧元。此外，LAAO 与标准护理相比，具有更好的健康结果。
对于合并抗凝禁忌的 AF 患者，与标准护理相比，LAAO 的治疗可以被认为是具有成本效益的，从瑞典医疗保健和公共部门的角度来看。
