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Published on: February 28, 2012
Cost Implications of Left Atrial Appendage Occlusion During Cardiac Surgery: A Cost Analysis of the LAAOS III Trial
Adam Eqbal1, Wesley Tong2, Andre Lamy1,2
1Division of Cardiac Surgery McMaster University Ontario Hamilton Canada.
Insights
Left atrial appendage (LAA) occlusion during cardiac surgery significantly reduces stroke risk and is cost-saving. This strategy is economically dominant for patients with atrial fibrillation and high stroke risk.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Medical Technology Assessment
Background:
- The LAAOS III trial showed left atrial appendage (LAA) occlusion reduces stroke risk in atrial fibrillation patients undergoing cardiac surgery.
- This analysis examines the economic impact of LAA occlusion compared to no occlusion.
Purpose of the Study:
- To evaluate the cost implications of concomitant LAA occlusion versus no occlusion during cardiac surgery.
- To determine if LAA occlusion is a cost-effective strategy for stroke prevention in this patient population.
Main Methods:
- Utilized LAAOS III trial data to compare costs from the Centers for Medicare and Medicaid Services perspective.
- Applied Medicare reimbursement costs to cardiovascular events and performed sensitivity analyses on stroke costs and occlusion techniques.
Main Results:
- LAA occlusion cost $3878 per participant versus $4490 for no occlusion, a saving of $612 per participant.
- Primary cost savings were driven by a reduction in stroke events, with a mean difference of -$1021.
- LAA occlusion was cost-saving with suture and stapler techniques, but not with closure devices.
Conclusions:
- Concomitant LAA occlusion is a cost-saving strategy for patients in the LAAOS III trial.
- LAA occlusion is an economically dominant approach for patients with atrial fibrillation and a CHA₂DS₂-VASc score ≥2 undergoing cardiac surgery.
Abstract:
Background The LAAOS III (Left Atrial Appendage Occlusion Study) clinical trial demonstrated that concomitant left atrial appendage (LAA) occlusion leads to a lower risk of ischemic stroke or systemic embolism compared with no occlusion in participants with atrial fibrillation and a CHA2DS2-VASc score of ≥2 undergoing cardiac surgery for another indication. We report the cost implications of concomitant LAA occlusion during cardiac surgery. Methods and Results Using LAAOS III data, we compared the costs (in US dollars) associated with LAA occlusion to no occlusion from the perspective of the Centers for Medicare and Medicaid Services. We calculated the average cost per participant during the trial by applying Medicare reimbursement costs to cardiovascular events for all trial participants. We conducted sensitivity analyses, varying the cost of stroke ±25% and occlusion technique use. Cost neutrality was defined as a mean cost difference within ±5% of the cost per participant in the no-occlusion group. Total study cost per participant was $3878 in the LAA occlusion group and $4490 in the no-occlusion group, a mean difference of -$612 (95% CI, -$1276 to $45). The main drivers of cost savings were fewer stroke events during the trial (mean difference of -$1021). In sensitivity analyses, LAA occlusion was cost saving for suture and stapler techniques but more expensive with closure device. Conclusions Concomitant LAA occlusion was cost saving for participants in LAAOS III. Our findings support concomitant LAA occlusion as an economically dominant strategy for patients with atrial fibrillation and a CHA2DS2-VASc score of ≥2 undergoing cardiac surgery.
