Table 4:

Results of Economic Literature Review—Patients With Nonvalvular Atrial Fibrillation Without Contraindications to Oral Anticoagulants

Author, Year, Location	Study Design and Perspective	Population/Comparator	Interventions	Results
				Health Outcomes	Costs	Cost-Effectiveness	Probability LAAC Device Is Cost-Effective (WTP Threshold)
Amorosi et al, 2015, Germany39	Decision tree German health payer perspective 10-year model	No description	LAAC device NOAC: dabigatran Other: warfarin	Risk of all-cause mortality LAAC device = 28.5% Dabigatran = 30.3% Warfarin = 38.6%	LAAC device = €16,736/person Dabigatran = < €20,000/person Warfarin = €15,158/person	No direct comparison provided vs. dabigatran €15,544/life saved vs. warfarin	N/A
Freeman et al, 2016, United States34	Markov cohort model Ideal insurer perspective (U.S.), inpatient and outpatient medical care and prescription costs Lifetime model	Patients with AF at increased risk for stroke (CHADS2 ≤ 1) and no contradictions to OACs Age = 70 years	LAAC device NOAC: dabigatran Other: warfarin	Based on PROTECT AF40 LAAC device = 9.94 QALYs/person Dabigatran = 8.28 QALYs/person Warfarin = 7.96 QALYs/person Based on PREVAIL20 LAAC device = 8.44 QALYs/person Dabigatran = 8.59 QALYs/person Warfarin = 8.54 QALYs/person 3% discount rate	Based on PROTECT AF40 LAAC device = $132,844/person Dabigatran = $94,072/person Warfarin = $92,120/person Based on PREVAIL20 LAAC device = $120,977/person Dabigatran = $83,746/person Warfarin = $73,077/person 3% discount rate, USD	Based on PROTECT AF40 $23,422/QALY vs. dabigatran $20,486/QALY vs. warfarin Based on PREVAIL20 Dominated vs. dabigatran Dominated vs. warfarin	vs. all comparators: 89% ($50,000/QALY)
Lee et al, 2016, United States35	Markov cohort model U.S. health care provider perspective Lifetime model	Patients with NVAF and no contraindications to antithrombotic therapies Age = 65 years	LAAC device NOACs ○ Apixapan ○ Dabigatran 110 mg ○ Dabigatran 150 mg ○ Rivaroxaban Other ○ Aspirin ○ Aspirin + clopidogrel ○ Warfarin	LAAC device = 10.99 QALYs/person Apixaban = 9.40 QALYs/person Dabigatran 110 mg = 8.76 QALYs/person Dabigatran 150 mg = 9.00 QALYs/person Rivaroxaban = 9.86 QALYs/person Aspirin = 6.12 QALYs/person Aspirin + clopidogrel = 6.29 QALYs/person Warfarin = 9.45 QALYs/person 3% discount rate	LAAC device = $37,789/person Apixaban = $53,315/person Dabigatran 110 mg = $42,712/person Dabigatran 150 mg = $43,946/person Rivaroxaban = $51,064/person Aspirin = $12,877/person Aspirin + clopidogrel = $26,287/person Warfarin = $28,090/person 3% discount rate, USD	Dominant vs. apixaban Dominant vs. dabigatran 110 mg Dominant vs. dabigatran 150 mg Dominant vs. rivaroxaban $5,115/QALY vs. aspirin $2,447/QALY vs. aspirin + clopidogrel $6,298/QALY vs. warfarin	vs. all comparators: 86.24% ($50,000/QALY)
Micieli et al, 2016, Canada37	Markov microsimulation Ontario Ministry of Health and Long-Term Care perspective Lifetime model	Patients with new onset NVAF, at risk for stroke and with no contraindications to OACs Age (mean) = 68.9 Male = 52.1%	LAAC device NOACs ○ Apixaban ○ Dabigatran ○ Rivaroxaban Other ○ Warfarin	LAAC device = 5.21 QALYs/person Apixaban = 5.25 QALYs/person Dabigatran = 5.18 QALYs/person Rivaroxaban = 5.21 QALYs/person Warfarin = 5.13 QALYs/person 5% discount rate	LAAC device = $21,789/person Apixaban = $19,156/person Dabigatran = $20,974/person Rivaroxaban = $18,280/person Warfarin = $15,776/person 5% discount rate, CAD	Dominated vs. apixaban $33,167/QALY vs. dabigatran Dominated vs. rivaroxaban $75,162 vs. warfarin	vs. all comparators: 31.9% ($50,000/QALY)
Reddy et al, 2015, United States33	Markov cohort model Centers for Medicare & Medicaid Services (U.S.) perspective Lifetime model	Patients with NVAF CHA2DS2VASc (mean) = 3.2 HAS-BLED (mean) = 2 Age = 70 years	LAAC device NOACs (as a class) Other ○ Warfarin	At 5 Years LAAC device = 3.45 QALYs/person NOACs = 3.45 QALYs/person Warfarin = 3.39 QALYs/person At 20 Years LAAC device = 8.03 QALYs/person NOACs = 7.68 QALYs/person Warfarin = 7.39 QALYs/person 3% discount rate	At 5 Years LAAC device = $20,892/person NOACs = $20,924/person Warfarin = $10,746/person At 20 Years LAAC device = $31,198/person NOACs = $61,701/person Warfarin = $49,946/person 3% discount rate, USD	At 5 Years Dominant vs. NOACs $149,468/QALY vs. warfarin At 20 Years Dominant vs. NOACs Dominant vs. warfarin	vs. NOACs: 95% ($50,000/QALY) vs. warfarin: 94% ($50,000/QALY)
Singh et al, 2013, Canada38	Markov microsimulation Ontario Ministry of Health and Long-Term Care perspective Lifetime model	Patients with NVAF at risk for stroke with no contraindications to OACs Age (mean) = 76 years Male = 50%	LAAC device NOAC ○ Dabigatran Other ○ Warfarin	LAAC device = 4.68 QALYs/person Dabigatran = 4.64 QALYs/person Warfarin = 4.55 QALYs/person 5% discount rate	LAAC device = $27,003/person Dabigatran = $25,760/person Warfarin = $21,429/person 5% discount rate, CAD	$30,256 vs. dabigatran $41,565/QALY vs. warfarin	vs. warfarin: 43% ($50,000/QALY)

Abbreviations: AF, atrial fibrillation; CHADS₂, Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus, Stroke or transient ischemic attack symptoms previously (2 points); CHADS₂DS₂VASc, Congestive heart failure, Hypertension, Age ≥ 75 years (2 points), Diabetes mellitus, Stroke or transient ischemic attack symptoms previously (2 points), Vascular disease, Age 65–74 years, Sex category; HAS-BLED, Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile international normalized ratios (INRs), Elderly, Drugs or alcohol; LAAC device, left atrial appendage closure device with delivery system; N/A, not applicable; NOAC, novel oral anticoagulant; NVAF, nonvalvular atrial fibrillation; OAC, oral anticoagulant; PROTECT AF, Watchman Left Atrial Appendage System for Embolic Protection in Patients with Atrial Fibrillation; QALY, quality-adjusted life-year; RE-LY, Randomized Evaluation of Long-Term Anticoagulation Therapy; WTP, willingness to pay.