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Updated: Jul 13, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Cost-effectiveness of left atrial appendage closure with Watchman for non-valvular atrial fibrillation patients in
Isao Kamae1, Yue Zhong2, Hidehiko Hara3
1Graduate School of Public Policy, University of Tokyo, Tokyo, Japan.
Insights
Left atrial appendage closure (LAAC) is cost-saving for stroke prevention in non-valvular atrial fibrillation (NVAF) patients in Japan. This method offers better quality-of-life compared to warfarin and direct oral anticoagulants (DOACs).
Area of Science:
- Cardiology
- Health Economics
- Medical Technology
Background:
- Non-valvular atrial fibrillation (NVAF) poses a significant stroke risk.
- Oral anticoagulants (warfarin, DOACs) are standard stroke prophylaxis.
- Left atrial appendage closure (LAAC) is an alternative stroke reduction strategy.
Purpose of the Study:
- To assess the cost-effectiveness of LAAC using the Watchman device versus warfarin and DOACs for stroke risk reduction in Japanese NVAF patients.
- To evaluate LAAC from a public healthcare payer perspective in Japan.
Main Methods:
- A Markov model was utilized with a lifetime time horizon for 70-year-old patients.
- Clinical data for LAAC were sourced from the PROTECT AF and PREVAIL trials.
- Warfarin and DOAC data were derived from published meta-analyses; cost data from the Japanese Medical Data Vision database.
Main Results:
- LAAC was less costly than warfarin (JPY 1,878,335 savings) and DOACs (JPY 1,198,096 savings) over a lifetime.
- LAAC yielded more quality-adjusted life years (QALYs) than warfarin (1.500) and DOACs (0.996).
- Probabilistic sensitivity analysis indicated LAAC was cost-effective in over 99% of simulations for both comparators.
Conclusions:
- Left atrial appendage closure (LAAC) is a cost-saving strategy for stroke risk reduction in Japanese NVAF patients.
- LAAC is associated with improved quality-of-life compared to warfarin and DOACs.
- The Watchman device presents a favorable economic and clinical profile for NVAF management in Japan.
Aims:
Left atrial appendage closure (LAAC) has been demonstrated to be cost-saving relative to oral anticoagulants for stroke prophylaxis in patients with non-valvular atrial fibrillation (NVAF) in the United States and Europe. This study assessed the cost-effectiveness of LAAC with the Watchman device relative to warfarin and direct oral anticoagulants (DOACs) for stroke risk reduction in NVAF from a Japanese public healthcare payer perspective.
Methods:
A Markov model was developed with 70-year-old patients using a lifetime time horizon. LAAC clinical inputs were from pooled, 5-year PROTECT AF and PREVAIL trials; warfarin and DOAC inputs were from published meta-analyses. Baseline stroke and bleeding risks were from the SALUTE trial on LAAC. Cost inputs were from the Japanese Medical Data Vision database. Probabilistic and one-way sensitivity analyses were performed.
Results:
Over the lifetime time horizon, LAAC was less costly than warfarin (savings of JPY 1,878,335, equivalent to US $17,600) and DOACs (savings of JPY 1,198,096, equivalent to US $11,226). LAAC also provided 1.500 more incremental quality-adjusted life years (QALYs) than warfarin and 0.996 more than DOACs. In probabilistic sensitivity analysis, LAAC was cost-effective relative to warfarin and DOACs in 99.98% and 99.73% of simulations, respectively. LAAC dominated (had higher cumulative QALYs and was less costly than) warfarin and DOACs in 89.94% and 83.35% of simulations, respectively.
Conclusions:
Over a lifetime time horizon, LAAC is cost-saving relative to warfarin and DOACs for stroke risk reduction in NVAF patients in Japan and is associated with improved quality-of-life.
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