News | Left Atrial Appendage (LAA) Occluders | January 06, 2016

New Study Demonstrates Cost-Effectiveness of Watchman Device

Long-term analysis shows cost-effectiveness of left atrial appendage closure device over warfarin, NOACs, in reducing stroke risk in non-valvular atrial fibrillation patients

Watchman, LAA closure device, cost effectiveness, VIvek Reddy, stroke reduction, study

January 6, 2016 — A new study determined that the Watchman left atrial appendage closure device is more cost-effective than warfarin and non-warfarin oral anticoagulants (NOACs) for stroke reductions in non-valvular atrial fibrillation patients. The study — led by Vivek Reddy, M.D., director of cardiac arrhythmia services for The Mount Sinai Hospital and Mount Sinai Health System — was published online and in the December 22 issue of the Journal of American College of Cardiology (JACC).

Atrial fibrillation, a heart rhythm malfunction that affects nearly 6 million Americans, puts patients at a significantly greater risk of stroke, which can be both debilitating and costly. With nearly $8 billion spent annually on atrial fibrillation-associated strokes, researchers aimed to determine the cost effectiveness of three atrial fibrillation treatments: warfarin, NOACs and the Watchman device.

“By its very nature, the Watchman device is not subject to patient adherence issues, since once implanted, the device provides lifelong stroke prophylaxis without the risk of complications associated with blood thinners,” said Reddy. “This is crucial both in improving patient outcomes by reducing disabling strokes, as well as reducing healthcare costs.”

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.

The Watchman device, made by Boston Scientific and approved by the U.S. Food and Drug Administration (FDA) in March 2015, is implanted into the heart to close off the left atrial appendage, a blind pouch of heart tissue where blood clots form; clots can then break off and travel in the bloodstream to the brain and cause strokes. It is inserted through a vein in the leg during a one-time, minimally invasive, catheter-based procedure in the electrophysiology laboratory.

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 three-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:

  • 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; and
  • The 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.

Reddy served as co-principal investigator for national clinical trials testing the Watchman device, and has served as a consultant to Boston Scientific.

For more information: www.mountsinai.org

Related Content

Atrial Fibrillation Patients Diagnosed With Carotid Atery Disease Face Increased Risk of Dementia

Image courtesy of Intermountain Medical Center Heart Institute

News | Atrial Fibrillation | May 24, 2018
Atrial fibrillation patients who are diagnosed with carotid artery disease face higher risks for developing dementia,...
Botulinum Toxin (botox) Injection in CABG Patients Reduces AFib After Cardiac Surgery. #HRS2018

Figure 1: At the end of 36 months, the incidence of any atrial tachyarrhythmia was 23.3 percent in the botox group, as compared to 50 percent in the placebo group

News | Atrial Fibrillation | May 18, 2018
 
Atrial fibrillation ablation using the Abbott Ensite electro mapping system. CABANA Trial Confirms Ablation Equal To or Superior to Drug Therapy. #HRS2018

Atrial fibrillation ablation using the Abbott Ensite electro mapping system.

Feature | Atrial Fibrillation | May 17, 2018
May 16, 2018 – The first results of the randomized, multicenter, long-term, international...
Link Found Between Post-Traumatic Stress, Increased Risk of AFib. #HRS2018
News | Atrial Fibrillation | May 15, 2018
May 15, 2018 — A new study is the first to report a relationship between post-traumatic stress disorder (PTSD) and ne
Marijuana Use Does Not Increase Risk of Arrhythmias, Might Reduce AFib Risk. #HRS2018
News | Atrial Fibrillation | May 15, 2018
May 15, 2018 — According to new research, smoking marijuana may not be associated with an increased risk of ventricul
First Results Reported from AVIATOR 2 Registry for AFib Patients Undergoing PCI.

Photo courtesy of the American Heart Association

News | Atrial Fibrillation | May 15, 2018
May 15, 2018 – Results of the AVIATOR 2 international registry data show a discrepancy between physician perception a
New Combined Risk Score More Effectively Predicts Stroke Risk in AFib Patients

Image courtesy of Intermountain Medical Center Heart Institute

News | Atrial Fibrillation | May 11, 2018
A new study finds that integrating two separate clinical risk score models more accurately helps clinicians assess the...
Depression Linked to Increased Atrial Fibrillation Risk
News | Atrial Fibrillation | March 27, 2018
March 27, 2018 — Depression may increase the risk for...
Boston Scientific's Apama multi-electrode ablation balloon to treat atrial fibrillation.

Boston Scientific's Apama multi-electrode ablation balloon to treat atrial fibrillation. The technology allows different energies to be used for each electrode to prevent damage to the esophagus or other underlying critical structures. 

Feature | Atrial Fibrillation | January 15, 2018 | Dave Fornell
The development of atrial fibrillation (AFib or AF) ablation technologies over the past 20 years has been a constant
Overlay Init