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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Cost-effectiveness of pharmacologic and invasive therapies for stroke prophylaxis in atrial fibrillation

Matthew D Solomon1, Aditya J Ullal, Donald D Hoang

  • 1Veterans Affairs Palo Alto Healthcare System, Palo Alto, California 94304, USA.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|December 24, 2011
PubMed

Insights

Cost-effectiveness analysis (CEA) of atrial fibrillation stroke prevention strategies is crucial. This review examines CEA for pharmacologic and device-based therapies, informing clinical and health policy decisions for stroke risk reduction.

Area of Science:

  • Cardiology
  • Health Economics
  • Preventive Medicine

Background:

  • Atrial fibrillation (AF) is a common arrhythmia linked to a significant stroke burden.
  • Current stroke prevention in AF involves anticoagulants (warfarin, novel agents) and antiplatelets.
  • Non-pharmacologic options include left atrial appendage exclusion (surgical, percutaneous, device-based).

Purpose of the Study:

  • To review the principles of cost-effectiveness analysis (CEA).
  • To identify and synthesize existing CEA studies on stroke prevention in atrial fibrillation.
  • To discuss the economic value of various prophylactic strategies, including emerging therapies.

Main Methods:

  • Systematic literature review of CEA studies.
  • Identification of 11 relevant articles examining stroke prophylaxis in AF.
  • Analysis of studies evaluating aspirin, warfarin, novel oral anticoagulants, and device-based therapies.

Main Results:

  • Most reviewed studies focus on aspirin and warfarin across different AF stroke risk levels.
  • Emerging literature on direct thrombin inhibitors and their cost-effectiveness is discussed.
  • The potential value of device-based stroke prevention therapies is considered.

Conclusions:

  • CEA provides valuable insights for optimizing stroke prevention in atrial fibrillation.
  • Evidence synthesis supports informed clinical and health policy recommendations.
  • Further CEA is warranted for newer pharmacologic and device-based interventions in AF stroke prophylaxis.

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