Table 25:
Scenario Analyses Results
| Strategy | Average Total Costs, $ | Incremental Cost of LAAC,a $ | Average Total QALYs | Incremental QALYs of LAACb | ICER of LAAC Devicec | Probability Treatment Is Cost-Effectived |
|---|---|---|---|---|---|---|
| Scenario 1: High Risk of Bleeding (HAS-BLED = 4) | ||||||
| Intervention | ||||||
| LAAC device | 42,904 | 5.48 | 0.04 | |||
| Comparator | ||||||
| Apixaban | 28,751 | 14,153 | 5.63 | −0.15 | Dominatede | 0.47 |
| Dabigatran | 28,124 | 14,780 | 5.62 | −0.14 | Dominatede | 0.47 |
| Rivaroxaban | 33,125 | 9,779 | 5.55 | −0.07 | Dominatede | 0.01 |
| Warfarin | 27,266 | 15,638 | 5.43 | 0.05 | $312,760/QALY | 0.00 |
| Scenario 2: Procedural and Nonprocedural Stroke and Major Bleeds | ||||||
| Intervention | ||||||
| LAAC device | 31,214 | 6.12 | 0.12 | |||
| Comparator | ||||||
| Apixaban | 20,879 | 10,335 | 6.07 | 0.05 | $206,700/QALY | 0.41 |
| Dabigatran | 20,627 | 10,587 | 6.08 | 0.04 | $264,675/QALY | 0.47 |
| Rivaroxaban | 25,830 | 5,384 | 6.01 | 0.11 | $48,945/QALY | 0.00 |
| Warfarin | 19308 | 11,906 | 5.88 | 0.24 | $49,608/QALY | 0.00 |
| Scenario 3: Treatment Effects on All-Cause Mortality Included | ||||||
| Intervention | ||||||
| LAAC device | 42,638 | 5.71 | 0.03 | |||
| Comparator | ||||||
| Apixaban | 26,953 | 15,685 | 5.84 | −0.13 | Dominatede | 0.39 |
| Dabigatran | 26,301 | 16,337 | 5.84 | −0.13 | Dominatede | 0.57 |
| Rivaroxaban | 31,250 | 11,388 | 5.79 | −0.08 | Dominatede | 0.01 |
| Warfarin | 24,726 | 17,912 | 5.6 | 0.11 | $162,836/QALY | 0.00 |
| Scenario 4: Costs of Stroke, Bleed, and Transient Ischemic Attack Obtained From Ontario Case Costing Initiative73 | ||||||
| Intervention | ||||||
| LAAC device | 26,795 | 5.66 | 0.04 | |||
| Comparator | ||||||
| Apixaban | 14,942 | 11,853 | 5.79 | −0.13 | Dominatede | 0.53 |
| Dabigatran | 15,473 | 11,322 | 5.79 | −0.13 | Dominatede | 0.42 |
| Rivaroxaban | 19,831 | 6,964 | 5.73 | −0.07 | Dominatede | 0.01 |
| Warfarin | 12,035 | 14,790 | 5.58 | 0.08 | $184,875/QALY | 0.00 |
| Scenario 5: Cost of Novel Oral Anticoagulant Reversal Agent Included | ||||||
| Intervention | ||||||
| LAAC device | 41,162 | 5.67 | 0.02 | |||
| Comparator | ||||||
| Apixaban | 27,457 | 13,705 | 5.82 | −0.15 | Dominatede | 0.53 |
| Dabigatran | 27,003 | 14,159 | 5.81 | −0.14 | Dominatede | 0.44 |
| Rivaroxaban | 31,616 | 9,546 | 5.77 | −0.04 | Dominatede | 0.01 |
| Warfarin | 24,642 | 16,520 | 5.62 | 0.05 | $330,400/QALY | 0.00 |
| Scenario 6: Treating All Patients Aged 65 Years or Older | ||||||
| Intervention | ||||||
| LAAC device | 40,787 | 5.67 | 0.00 | |||
| Comparator | ||||||
| Apixaban | 25,849 | 14,938 | 5.82 | −0.15 | Dominatede | 0.47 |
| Dabigatran | 25,462 | 15,325 | 5.82 | −0.15 | Dominatede | 0.52 |
| Rivaroxaban | 30,247 | 10,540 | 5.75 | −0.08 | Dominatede | 0.01 |
| Warfarin | 24,093 | 16,694 | 5.62 | 0.05 | $333,880/QALY | 0.00 |
| Scenario 7: LAAC Device Adverse Events and Surgical Outcomes From PREVAIL Trial Only | ||||||
| Intervention | ||||||
| LAAC device | 40,662 | 5.68 | 0.00 | |||
| Comparator | ||||||
| Apixaban | 26,096 | 14,566 | 5.84 | −0.16 | Dominatede | 0.47 |
| Dabigatran | 25,493 | 15,169 | 5.83 | −0.15 | Dominatede | 0.53 |
| Rivaroxaban | 30,210 | 10,452 | 5.76 | −0.08 | Dominatede | 0.00 |
| Warfarin | 24,126 | 16,536 | 5.62 | 0.08 | $206,700/QALY | 0.00 |
| Scenario 8: Proportion of Disabling and Nondisabling Stroke Modelled From the PROTECT AF Trial | ||||||
| Intervention | ||||||
| LAAC device | 38,165 | 5.81 | 0.20 | |||
| Comparator | ||||||
| Apixaban | 28,725 | 9,440 | 5.83 | −0.02 | Dominatede | 0.38 |
| Dabigatran | 27,929 | 10,236 | 5.82 | −0.01 | Dominatede | 0.40 |
| Rivaroxaban | 33,021 | 5,144 | 5.76 | 0.05 | 102,880 | 0.01 |
| Warfarin | 27,253 | 10,912 | 5.65 | 0.16 | 68,200 | 0.00 |
Abbreviations: ICER, incremental cost-effectiveness ratio; LAAC device, left atrial appendage closure device with delivery system; QALY, quality-adjusted life-year.
a
Incremental costs = average costs (LAAC) – average costs (comparator).
b
Incremental QALYs = average QALYs (LAAC) – average QALYs (comparator).
c
ICER = incremental costs ÷ incremental QALYs.
d
At a willingness-to-pay threshold of $50,000/QALY.
e
Higher costs, lower QALYs.