COST-UTILITY ANALYSIS OF LEFT ATRIAL APPENDAGE OCCLUDER DEVICES FOR ATRIAL FIBRILLATION PATIENTS WITH CONTRAINDICATIONS TO ORAL ANTICOAGULATION THERAPY IN THAILAND...
Author(s)
Unchalee Permsuwan, Ph.D.1, Mann Chandavimol, M.D.2, Varistha Phetcharakupt, M.D.2, Suphot Srimahachota, M.D.3, Ronpichai Chokesuwattanaskul, M.D.3, Rungroj Krittayaphong, M.D.4, Satchana Pumprueg, M.D.4, Jirawit Yadee, Pharm.D., 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, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, 3Division of Cardiology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand, 4Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj 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, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, 3Division of Cardiology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand, 4Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
OBJECTIVES: Left atrial appendage occluder (LAAO) devices are increasingly used as a safe and effective strategy to reduce stroke risk in patients with atrial fibrillation (AF) who are unable to receive long-term oral anticoagulant therapy. This study assessed the cost-utility of adding an LAAO device to standard of care (SoC) for Thai patients with non-valvular AF (NVAF) who had contraindications to anticoagulant therapy.
METHODS: A two-part model was developed to estimate lifetime costs, life years (LYS), and quality-adjusted life years (QALYs). The cohorts included patients at high risk of intracranial hemorrhage, severe major bleeding, life-threatening bleeding, severe drug allergies or drug interactions associated with anticoagulants. Model inputs for mortality, complications, costs, and utilities were directly collected from the three largest university-affiliated hospitals. Costs and outcomes were discounted at an annual rate of 3% and presented as 2025 values. Incremental cost-effectiveness ratios (ICERs) were calculated as additional costs per QALY gained. Deterministic and probabilistic sensitivity analyses were performed to assess model uncertainty.
RESULTS: LAAO plus SoC increased costs relative to SoC alone (USD 50,894 vs USD 27,916) from the societal perspective and (USD 31,149 vs USD 14,923) from the healthcare perspective. Adding LAAO also resulted in better outcomes, with gains of 10.31 LYs and 8.31 QALYs compared with 6.78 LYs and 5.11 QALYs for SoC alone. This yielded ICER of USD 7,190 and USD 5,078 per QALY gained from societal and healthcare perspectives, respectively.
CONCLUSIONS: In Thailand, adding LAAO to SoC appeared unlikely to be cost-effective at the willingness-to-pay threshold of USD 4,842 per QALY, as the estimated ICER was slightly above the threshold. However, LAAO provided additional health benefits and may become cost-effective if device costs and direct non-medical costs are reduced. These findings support future price negotiations and policy discussions regarding LAAO implementation in this group of populations.
METHODS: A two-part model was developed to estimate lifetime costs, life years (LYS), and quality-adjusted life years (QALYs). The cohorts included patients at high risk of intracranial hemorrhage, severe major bleeding, life-threatening bleeding, severe drug allergies or drug interactions associated with anticoagulants. Model inputs for mortality, complications, costs, and utilities were directly collected from the three largest university-affiliated hospitals. Costs and outcomes were discounted at an annual rate of 3% and presented as 2025 values. Incremental cost-effectiveness ratios (ICERs) were calculated as additional costs per QALY gained. Deterministic and probabilistic sensitivity analyses were performed to assess model uncertainty.
RESULTS: LAAO plus SoC increased costs relative to SoC alone (USD 50,894 vs USD 27,916) from the societal perspective and (USD 31,149 vs USD 14,923) from the healthcare perspective. Adding LAAO also resulted in better outcomes, with gains of 10.31 LYs and 8.31 QALYs compared with 6.78 LYs and 5.11 QALYs for SoC alone. This yielded ICER of USD 7,190 and USD 5,078 per QALY gained from societal and healthcare perspectives, respectively.
CONCLUSIONS: In Thailand, adding LAAO to SoC appeared unlikely to be cost-effective at the willingness-to-pay threshold of USD 4,842 per QALY, as the estimated ICER was slightly above the threshold. However, LAAO provided additional health benefits and may become cost-effective if device costs and direct non-medical costs are reduced. These findings support future price negotiations and policy discussions regarding LAAO implementation in this group of populations.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE82
Topic
Economic Evaluation
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)