COST-UTILITY ANALYSIS OF LEFT ATRIAL APPENDAGE OCCLUSION VERSUS ANTICOAGULANT THERAPY FOR ATRIAL FIBRILLATION PATIENTS AT HIGH RISK OF STROKE AND MAJOR BLEEDING IN THAILAND...
Author(s)
Jirawit Yadee, Pharm.D., Ph.D.1, Suphot Srimahachota, M.D.2, Ronpichai Chokesuwattanaskul, M.D.2, Rungroj Krittayaphong, M.D.3, Satchana Pumprueg, M.D.3, Mann Chandavimol, M.D.4, Varistha Phetcharakupt, M.D.4, Unchalee Permsuwan, Ph.D.1.
1Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand, 2Division of Cardiology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand, 3Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 4Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
1Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand, 2Division of Cardiology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand, 3Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 4Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
OBJECTIVES: Left atrial appendage occlusion (LAAO) is an alternative strategy for patients with atrial fibrillation (AF) who are at elevated risk of major bleeding. This study aimed to evaluate the cost-utility of LAAO compared with anticoagulant therapy in patients with non-valvular AF (NVAF) at high risk of stroke and major bleeding in Thailand.
METHODS: A two-part decision-analytic model was constructed to estimate lifetime costs, life years (LYS), and quality-adjusted life years (QALYs) from a societal perspective The study population consisted of patients with NVAF who had high stroke risk (CHA2DS2-VASc score ≥2 for men and ≥3 for women) and high risk of major bleeding (HAS-BLED score ≥3). Patient-level data on the effectiveness of LAAO, mortality, complications, costs, and utilities for this particular population were obtained from the three largest university-affiliated hospitals. Both costs and outcomes were discounted at an annual rate of 3% and expressed in 2025 values. Incremental cost-effectiveness ratio (ICER) was calculated as incremental costs per QALY gained. Deterministic and probabilistic sensitivity analyses were performed to assess model uncertainty.
RESULTS: LAAO was associated with higher lifetime costs than anticoagulant therapy (THB 2,033,062 [USD 61,523] vs THB 1,653,903 [USD 50,050]). In addition, LAAO yielded 13.02 LYs and 10.60 QALYs, compared with 12.51 LYs and 10.02 QALYs for anticoagulant therapy. The resulting ICER was THB 648,947 (USD 19,638) per QALY gained.
CONCLUSIONS: Under the Thai willingness-to-pay threshold of THB 160,000 per QALY (USD 4,842), LAAO is unlikely to represent a cost-effective strategy compared with anticoagulant therapy among NVAF patients at high risk of stroke and major bleeding. However, LAAO provided additional health benefits and may become more economically attractive if device prices decline.
METHODS: A two-part decision-analytic model was constructed to estimate lifetime costs, life years (LYS), and quality-adjusted life years (QALYs) from a societal perspective The study population consisted of patients with NVAF who had high stroke risk (CHA2DS2-VASc score ≥2 for men and ≥3 for women) and high risk of major bleeding (HAS-BLED score ≥3). Patient-level data on the effectiveness of LAAO, mortality, complications, costs, and utilities for this particular population were obtained from the three largest university-affiliated hospitals. Both costs and outcomes were discounted at an annual rate of 3% and expressed in 2025 values. Incremental cost-effectiveness ratio (ICER) was calculated as incremental costs per QALY gained. Deterministic and probabilistic sensitivity analyses were performed to assess model uncertainty.
RESULTS: LAAO was associated with higher lifetime costs than anticoagulant therapy (THB 2,033,062 [USD 61,523] vs THB 1,653,903 [USD 50,050]). In addition, LAAO yielded 13.02 LYs and 10.60 QALYs, compared with 12.51 LYs and 10.02 QALYs for anticoagulant therapy. The resulting ICER was THB 648,947 (USD 19,638) per QALY gained.
CONCLUSIONS: Under the Thai willingness-to-pay threshold of THB 160,000 per QALY (USD 4,842), LAAO is unlikely to represent a cost-effective strategy compared with anticoagulant therapy among NVAF patients at high risk of stroke and major bleeding. However, LAAO provided additional health benefits and may become more economically attractive if device prices decline.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE2
Topic
Economic Evaluation
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)