OBJECTIVES: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia which is a significant risk factor for stroke. Warfarin is the standard therapy for stroke prevention. Left atrial appendage closure (LAAC) with the WATCHMAN is a new proven effective stroke prevention strategy. Multiple clinical studies (PROTECT-AF and PREVAIL trials) have demonstrated the stroke prevention efficacy. However, no studies have evaluated the economic impact of the two strategies in China in non-valvular AF patients. The current study utilizes Chinese cost data to evaluate cost-effectiveness of LAAC versus long-term warfarin therapy for stroke risk reduction in AF patients. METHODS: A Markov model (30 years) was developed to estimate the cost-effectiveness of LAAC Vs. warfarin from government payer perspective. Clinical efficacy data and utility values were abstracted from the PROTECT-AF(4y) trial,  published meta-analysis by D. Holmes and published literatures.  Chinese local cost data is extracted from literature review and through a micro-costing study of 50 attending physicians at 12 tertiary hospitals located in representative cities of Beijing, Shanghai, Foshan, Nanjing, Hangzhou and Chengdu in China. RESULTS: LAAC was projected to increase life expectancy with an additional 0.984 quality-adjusted life years (QALYs) compared with warfarin with incremental total costs of RMB 94,233.75 yuan. The estimated 30 years (life time) incremental cost-effectiveness ratio was RMB 95,746.27 yuan per QALY with LAAC compared with warfarin, which was below the willingness-to-pay threshold recommended by WHO. Sensitivity analyses indicated that results were robust to a wide range of inputs.  CONCLUSIONS: The lifetime economic modeling study suggests that LAAC is a cost-effective alternative to warfarin in stroke prevention for AF patients in China