Fig. 1

Shows the result of ICER values in comparison of the next-best strategy, and the black line connected from acetylsalicylic acid (ASA) to LAA occlusion as the cost-effectiveness frontier. The effectiveness is defined as the change of quality adjusted life year (QALY) gained. The cost-effectiveness frontier ran from ASA to warfarin to LAA occlusion and its slope increased when moving from the least costly/least effective alternative (ASA) towards the most costly/most effective alternative (LAA occlusion). Clopidogrel plus ASA was an extended dominance* strategy. LAA occlusion is the next more-effective strategy comparing to warfarin, ICER per QALY gained was US$6,298. Dabigatran 110 mg, dabigatran 150 mg, rivaroxaban, and apixaban were dominated by LAA occlusion because those four alternatives were less effective but more costly than LAA occlusion. *Extended dominance: This refers to the observation when the ICER value for a given strategy is higher than that of the next, more effective, alternative. Clopidogrel plus ASA had a higher ICER value than a more effective alternative (warfarin)