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Table 4 Sensitivity analysis of total Costs, total QALYs, and ICERs of LAA occlusion compared with each strategy by varying CHADS2 score, HAS-BLED score, time horizons, and LAA occlusion costs

From: Cost-effectiveness analysis of left atrial appendage occlusion compared with pharmacological strategies for stroke prevention in atrial fibrillation

 

Aspirin

Clopidogrel + Aspirin

Warfarin

Dabigatran 110 mg

Dabigatran 150 mg

Apixaban

Rivaroxaban

LAAO

CHADS2 Score

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

0 (0 · 8 %)

$10,117

6 · 36

$24,998

6 · 42

$27,027

9 · 54

$41,569

8 · 87

$43,685

9 · 02

$52,949

9 · 44

$50,966

9.98

$37,567

11.01

1 (2 · 2 %)

$12,073

6 · 19

$26,627

6 · 25

$30,565

9 · 25

$44,469

8 · 60

$46,627

8 · 75

$55,868

9 · 15

$54,107

9.67

$40,971

10.65

2 (4 · 5 %)

$15,048

5.93

$29,098

5 · 99

$35,853

8 · 81

$48,807

8 · 20

$51,021

8 · 34

$60,207

8 · 71

$58,766

9.19

$46,033

10.11

3 (8 · 6 %)

$19,710

5 · 52

$32,949

5 · 57

$43,894

8 · 11

$55,412

7 · 57

$57,698

7 · 69

$66,749

8 · 01

$65,765

8.44

$53,661

9.25

4 (10 · 9 %)

$22,017

5 · 31

$34,846

5 · 36

$47,753

7 · 76

$58,587

7 · 25

$60,899

7 · 37

$69,859

7 · 67

$69,080

8.07

$57,288

8.83

5 (12.3 %)

$23,327

5.19

$35,919

5.24

$49,905

7.57

$60,359

7.07

$62,684

7.18

$71,586

7.47

$70,915

7.86

$59,299

8.59

6 (13.7 %)

$24,571

5.08

$36,937

5.13

$51,922

7.38

$62,021

6.90

$64,357

7.01

$73,198

7.28

$72,626

7.66

$61,177

8.36

ICER, US$ LAAO vs. each strategy

Score 0: $5,903

Score 0: $2,738

Score 0: $7,170

     

Score 1: $6,479

Score 1: $3,260

Score 1: $7,433

     

Score 2: $7,413

Score 2: $4,110

Score 2: $7,831

     

Score 3: $9,102

Score 3: $5,628

Score 3: $8,568

Dominated

Dominated

Dominated

Dominated

---

Score 4: $10,020

Score 4: $6,467

Score 4: $8,911

     

Score 5: $10,580

Score 5: $6,979

Score 5: $9,210

     

Score 6: $11,160

Score 6: $7,505

Score 6: $9,444

     

HAS-BLED Score

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

0 (1.13 %)

$12,877

6 · 12

$26,287

6 · 29

$36,827

9 · 40

$62,062

8 · 64

$61,719

8 · 88

$72,551

9 · 30

$69,642

9.78

$38,858

10.98

1 (1.08 %)

$12,877

6 · 12

$26,287

6 · 29

$34,333

9 · 42

$59,791

8 · 66

$59,450

8 · 89

$69,999

9 · 31

$66,679

9.79

$38,552

10.99

2 (1.88 %)

$12,877

6 · 12

$26,287

6 · 29

$53,095

9 · 31

$76,902

8 · 55

$76,534

8 · 77

$89,207

9 · 21

$88,969

9.69

$40,851

10.97

3 (3.74 %)

$12,877

6 · 12

$26,287

6 · 29

$88,462

9 · 09

$109,305

8 · 35

$108,814

8 · 55

$125,481

9 · 02

$130,998

9.50

$45,208

10.95

4 (8.7 %)

$12,877

6 · 12

$26,287

6.29

$156,713

8 · 67

$172,530

7 · 94

$171,469

8 · 09

$195,786

8 · 65

$212,146

9.13

$53,713

10.89

5 (12.5 %)

$12,877

6 · 12

$26,287

6.29

$191,794

8 · 45

$205,517

7 · 73

$203,929

7 · 85

$232,133

8 · 45

$253,872

8.94

$58,139

10.87

ICER, US$ LAAO vs. each strategy

Score 0: $5,346

Score 0: $2,680

Score 0: $1,285

     

Score 1: $5,272

Score 1: $2,610

Score 1: $2,687

     

Score 2: $5,768

Score 2: $3,112

Score 2: Dominated

     

Score 3: $6,694

Score 3: $4,060

Score 3: Dominated

Dominated

Dominated

Dominated

Dominated

---

Score 4: $8,561

Score 4: $5,962

Score 4: Dominated

     

Score 5: $9,529

Score 5: $6,955

Score 5: Dominated

Time horizon

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

5 years

$6,100

3 · 47

$12,529

3 · 50

$6,898

4 · 02

$17,516

3 · 94

$17,374

3 · 97

$20,356

4 · 03

$17,040

4.08

$24,015

4.25

10 years

$9,788

5 · 06

$19,929

5 · 15

$14,876

6 · 63

$29,508

6 · 36

$29,707

6 · 46

$35,233

6 · 63

$31,205

6.81

$29,026

7.28

15 years

$11,801

5 · 78

$24,048

5 · 92

$22,111

8 · 34

$37,471

7 · 85

$38,190

8 · 02

$45,834

8 · 31

$42,397

8.63

$33,699

9.44

ICER, US$ LAAO vs. each strategy

0 5 years: $22,968

0 5 years: $15,315

5 years: $74,422

5 years: $20,965

05 years: $23,718

5 years: $16,632

5 years: $41,029

 

10 years: $8,666

10 years: $4,217

10 years: $21,769

10 years: Dominated

10 years: Dominated

10 years: Dominated

10 years: Dominated

---

15 years: $5,983

15 years: $2,742

15 years: $10,535

15 years: Dominated

15 years: Dominated

15 years: Dominated

15 years: Dominated

 

LAAO costs

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

Cost

QALY

 Low cost ($20,384)

$12,877

6.12

$26,287

6.29

$28,090

9.45

$42,712

8.76

$43,946

9.00

$53,315

9.40

$51,064

9.86

$36,731

10.99

 Base-case ($22,500)

$12,877

6.12

$26,287

6.29

$28,090

9.45

$42,712

8.76

$43,946

9.00

$53,315

9.40

$51,064

9.86

$37,789

10.99

 High cost ($24,614)

$12,877

6.12

$26,287

6.29

$28,090

9.45

$42,712

8.76

$43,946

9.00

$53,315

9.40

$51,064

9.86

$38,846

10.99

ICER, US$ LAAO vs. each strategy

Low cost: $4,898

Low cost: $2,222

Low cost: $5,611

     

Base-case: $5,115

Base-case: $2,447

Base-case: $6,298

Dominated

Dominated

Dominated

Dominated

---

High cost: $5,332

High cost: $2,672

High cost: $6,984

     
  1. Abbreviations: LAAO left atrial appendage occlusion, ICER incremental cost-effectiveness ratio, QALY quality-adjusted life year, CHADS 2 congestive heart failure, hypertension, age > 75, diabetes mellitus, and previous stroke/transient ischemic attack, HAS-BLED hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, Labile international normalized ratio, Elderly (>65 years), drugs/alcohol concomitantly, ICER calculated as the difference in cost divided by the difference in QALYs for each therapy compared with LAAO strategy, Dominated LAAO is less costly but more effective strategy compare with each strategy
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BMC Cardiovascular Disorders

ISSN: 1471-2261

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