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Updated: May 2, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Center-Related Variation in Hospitalization Cost for Patients Undergoing Percutaneous Left Atrial Appendage Occlusion
Shivaraj Patil1, Chaitanya Rojulpote2, Abhijit Bhattaru3
1Division of Cardiology, Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA.
Insights
Hospital costs for Watchman device implantation vary significantly by center, not patient factors. Higher-volume centers reduce costs and variation, emphasizing the need to address center-specific cost differences for value-based care.
Area of Science:
- Cardiovascular Interventions
- Health Economics
- Medical Device Technology
Background:
- Percutaneous left atrial appendage occlusion using the Watchman device is increasingly utilized in the U.S.
- Understanding cost variations is crucial for optimizing healthcare resource allocation.
Purpose of the Study:
- To assess center-specific variations in total hospital costs for Watchman device implantation.
- To identify factors contributing to high hospitalization costs nationally.
Main Methods:
- Analysis of the 2016-2018 National Inpatient Database for adult patients undergoing elective Watchman procedures.
- Utilized mixed-effects models to evaluate center impact on costs, adjusting for patient and center characteristics and length of stay.
Main Results:
- A total of 30,175 patients had Watchman implantation with a median cost of $24,500, showing substantial inter-admission variability.
- Approximately 13% of cost variability was linked to the performing center, not patient-specific factors.
- Higher-volume centers exhibited lower costs and reduced cost variation. Low procedural volume, complications, congestive heart failure, and longer length of stay predicted higher costs.
Conclusions:
- Center-performing the procedure significantly contributes to the variation in total hospital costs for Watchman implantation.
- Addressing center-related cost variability is essential for achieving high-quality, value-based care in Watchman procedures.
Background:
The commercial use of percutaneous left atrial appendage occlusion with the Watchman device is increasing in the United States. The purpose of this study was to evaluate center-related variation in total hospital costs for Watchman device implantation and identify factors associated with high hospital costs at a national level.
Methods:
All adults undergoing elective left atrial appendage occlusion with Watchman were identified in the 2016-2018 National Inpatient Database. Mixed models were used to evaluate the impact of center on total hospital costs, adjusting for patient and center characteristics and length of stay.
Results:
A total of 30,175 patients underwent Watchman device implantation at a median cost of $24,500 and demonstrated significant variability across admissions (interdecile range, $13,900-37,000). Nearly 13% of the variability in patient-level costs was related to the center performing the procedure rather than patient factors. Higher-volume centers had lower total costs and demonstrated lesser total cost variation. Centers with low procedural volume, occurrence of procedural complications, congestive heart failure, and length of stay were independent predictors of a high-cost hospitalization. Though complications were associated with increased expenditure, they did not explain the observed cost variation related to the center.
Conclusions:
A significant proportion of variation in total hospital cost was attributable to the center performing the procedure. Addressing variability of Watchman-related costs is necessary to achieve high-quality value-based care.
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