Evidence map›Paper›PMID 26838691›Full record

ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2016

Cost effectiveness of left atrial appendage closure with the Watchman device for atrial fibrillation patients with absolute contraindications to warfarin.

Vivek Y Reddy, Ronald L Akehurst, Shannon O Armstrong, Stacey L Amorosi, Nic Brereton, Deanna S Hertz, David R Holmes

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Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

13 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Article
  6. Left atrial appendage closure with the watchman device reduces atrial fibrillation management costs.Clinical research in cardiology : official journal of the German Cardiac Society · 2022
    Article
  7. Review
  8. Long-term outcomes following percutaneous left atrial appendage closure in patients with atrial fibrillation and contraindications to anticoagulation.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2018
    Article
  9. [Current indications for left atrial appendage occlusion].Herzschrittmachertherapie & Elektrophysiologie · 2017
    Review
  10. Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Vivek Y ReddyMount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA vivek.reddy@mountsinai.org.
Ronald L AkehurstUniversity of Sheffield, Sheffield, UK.
Shannon O ArmstrongGfK, Wayland, MA, USA.
Stacey L AmorosiBoston Scientific, Marlborough, MA, USA.
Nic BreretonBresMed, Sheffield, UK.
Deanna S HertzGfK, Wayland, MA, USA.
David R HolmesMayo Clinic, Rochester, MN, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsAtrial fibrillation (AF) patients with contraindications to oral anticoagulation have had few options for stroke prevention. Recently, a novel oral anticoagulant, apixaban, and percutaneous left atrial appendage closure (LAAC) have emerged as safe and effective therapies for stroke risk reduction in these patients. This analysis assessed the cost effectiveness of LAAC with the Watchman device relative to apixaban and aspirin therapy in patients with non-valvular AF and contraindications to warfarin therapy. METHODS AND

resultsA cost-effectiveness model was constructed using data from three studies on stroke prevention in patients with contraindications: the ASAP study evaluating the Watchman device, the ACTIVE A trial of aspirin and clopidogrel, and the AVERROES trial evaluating apixaban. The cost-effectiveness analysis was conducted from a German healthcare payer perspective over a 20-year time horizon. Left atrial appendage closure yielded more quality-adjusted life years (QALYs) than aspirin and apixaban by 2 and 4 years, respectively. At 5 years, LAAC was cost effective compared with aspirin with an incremental cost-effectiveness ratio (ICER) of €16 971. Left atrial appendage closure was cost effective compared with apixaban at 7 years with an ICER of €9040. Left atrial appendage closure was cost saving and more effective than aspirin and apixaban at 8 years and remained so throughout the 20-year time horizon.

conclusionsThis analysis demonstrates that LAAC with the Watchman device is a cost-effective and cost-saving solution for stroke risk reduction in patients with non-valvular AF who are at risk for stroke but have contraindications to warfarin.

Indexed as

AnticoagulantsAspirinAtrial AppendageAtrial FibrillationCardiac Surgical ProceduresClopidogrelContraindicationsCost-Benefit AnalysisGermanyHumansMarkov ChainsModels, TheoreticalPyrazolesPyridonesQuality-Adjusted Life YearsQuality of LifeAnticoagulantsapixabanAspirinClopidogrelPyrazolesPyridonesTiclopidineWarfarinApixabanContraindicatedCost-effectiveness analysisLeft atrial appendage closureStroke preventionWatchman

Identifiers

PMID26838691
PMCPMC4927063

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.