Shannon Armstrong

The aim of this study was to analyse randomized controlled study and real-world outcomes of patients with non-valvular atrial fibrillation (NVAF) undergoing left atrial appendage closure (LAAC) with the Watchman device and to compare costs with available antithrombotic therapies.

Methods A Markov model was developed to assess the cost-effectiveness of LAAC, NOACs, and warfarin from the perspective of the Centers for Medicare & Medicaid Services over a lifetime (20-year) horizon. Patients were 70 years of age and at moderate risk for stroke and bleeding. Clinical event rates, stroke outcomes, and quality of life information were drawn predominantly from PROTECT AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients with Atrial Fibrillation) 4-year… Show more

Methods A Markov model was developed to assess the cost-effectiveness of LAAC, NOACs, and warfarin from the perspective of the Centers for Medicare & Medicaid Services over a lifetime (20-year) horizon. Patients were 70 years of age and at moderate risk for stroke and bleeding. Clinical event rates, stroke outcomes, and quality of life information were drawn predominantly from PROTECT AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients with Atrial Fibrillation) 4-year data and meta-analyses of warfarin and NOACs. Costs for stroke risk reduction therapies, treatment of associated acute events, and long-term care following disabling stroke were presented in 2015 U.S. dollars.

Results Relative to warfarin, LAAC was cost-effective at 7 years ($42,994/quality-adjusted life-years [QALY]), and NOACs were cost-effective at 16 years ($48,446/QALY). LAAC was dominant over NOACs by year 5 and warfarin by year 10. At 10 years, LAAC provided more QALYs than warfarin and NOACs (5.855 vs. 5.601 vs. 5.751, respectively). In sensitivity analyses, LAAC remained cost-effective relative to warfarin ($41,470/QALY at 11 years) and NOACs ($21,964/QALY at 10 years), even if procedure costs were doubled.

Conclusions Both NOACs and LAAC with the Watchman device were cost-effective relative to warfarin, but LAAC was also found to be cost-effective and to offer better value relative to NOACs. The results of this analysis should be considered when formulating policy and practice guidelines for stroke prevention in AF. Show less

To explore the cost impact on Swedish healthcare of incorporating one instillation of hexaminolevulinate hydrochloride (HAL) blue-light cystoscopy into transurethral resection of bladder tumour (TURBT) in patients with suspected new or recurrent non-muscle-invasive bladder cancer (NMIBC).

This analysis suggests that among AF patients at risk for stroke, bleeding-related costs to CMS are nearly 3 times greater with chronic warfarin compared to LAAC with WATCHMAN. This should be considered when assessing the overall cost benefit for non-pharmacological, stroke risk reduction therapies in AF.

Stacey L. Amorosi1, Shannon Armstrong2,*, Lisa Da Deppo3, Susan Garfield2 and Kenneth Stein4

Shannon Armstrong, Stacey L. Amorosi, Parashar Patel, Gavin C. Erickson, Kenneth Stein

Vivek Y. Reddy, Ronald L. Akehurst, Stacey L. Amorosi, Shannon Armstrong, Colin Taggart, Steve M. Beard, Chris Knight, David R. Holmes

Reddy VY, Akehurst RL, Amorosi SL, Armstrong S, Holmes DR

The objective of this study was to conduct a detailed assessment of the cost effectiveness of using hexaminolevulinate hydrochloride with blue light cystoscopy as an adjunct to white light versus white light alone at time of initial TURB. A probabilistic decision tree model was developed using using TreeAge Pro 2011 software.

ISPOR Poster Finalist Award