OBJECTIVES: Healthcare costs today are increasingly being shifted from payers to patients, yet few providers factor patient costs into treatment decisions.  Recent advancements in stroke prevention in atrial fibrillation (AF) have resulted in new treatment options where previously there were few. While the clinical benefit and cost effectiveness of these treatments are supported by a growing body of evidence, the cost impact to patients has not been explored. This analysis sought to quantify patient out-of-pocket costs for three stroke prevention strategies: warfarin, dabigatran and left atrial appendage closure (LAAC) with the Watchman Device.  METHODS: A patient-level budget impact model was used to assess total out-of-pocket spend on treatment and treatment-related complications over five years. 2015 Medicare deductibles and co-insurance rates were used to estimate spend for LAAC, acute clinical events and office visits. Average drug costs were calculated from the four states with the largest number of Medicare beneficiaries. Patient stay days were taken from HCUP and inpatient rehabilitation prospective payment system data. Clinical probabilities for LAAC and warfarin were taken from PROTECT AF 4-year data and for dabigatran from the RE-LY trial. RESULTS: The deductible for the LAAC procedure was $1,260. This compares to an average annual acquisition cost of roughly $345 for warfarin and $1,048 for dabigatran. First year total costs were $1,734, $1,023 and $1,335, for LAAC, warfarin and dabigatran, respectively. By the end of year 2, LAAC was less expensive with total costs of $2,353 compared to $2,702 (warfarin) and $2,865 (dabigatran). By year 5, LAAC was approximately half the cost of anticoagulants. CONCLUSIONS: Patient out-of-pocket costs for stroke prevention in AF are considerable and may represent a burden for many Medicare beneficiaries living on fixed incomes.  LAAC with the Watchman Device provides lifetime stroke prophylaxis without increased bleeding risk at a lower cost to patients.