OBJECTIVES: Stroke is a leading public health problem in terms of mortality and economic burden in Korea. Anticoagulants (AC) are the mainstay for ischemic stroke prevention in atrial fibrillation (AF), but many patients have contraindications to these drugs. A number of catheter-based left atrial appendage occlusion (LAAO) devices devised to eliminate the major cause of thromboembolism in AF patients have been commercialized in Europe but are not yet available in Korea. The purpose of this study is to perform a budget impact analysis of LAAO in patients with AF contraindicated to AC. Such analysis could help decision makers assign greater priority to stroke prevention in Korea. METHODS: A budget impact model (BIM) was developed based on the number of ischemic strokes and deaths prevented by LAAO. LAAO was compared to no stroke prevention since AF patients contraindicated to AC have no other alternatives. Sensitivity analyses on clinical and cost inputs were performed. RESULTS: LAAO demonstrated a benefit in terms of ischemic strokes and mortality avoided. The BIM was most sensitive to the patients’ baseline stroke risk factors, the treatment effect of LAAO, the cost of stroke management and the cost of the LAAO procedure. For instance, in high stroke risk patients with CHADSVASc score ≥ 6 one stroke can be avoided within five years by LAAO performed in just three patients. LAAO can become cost saving after four  years post LAAO procedure assuming that the cost of LAAO procedure is approximately ₩15,000,000, the total cost of stroke defined as direct and indirect cost in the first year is approximately ₩31,000,000 and the total cost in each subsequent year is around ₩12,500,000. CONCLUSIONS: This analysis highlights that LAAO can be a cost saving stroke prevention therapy in anticoagulation intolerant AF patients in medium to long term post LAAO procedure.