{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T07:13:48Z","timestamp":1778570028946,"version":"3.51.4"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>Once a patient with atrial fibrillation experiences an embolic event, the risk of a recurrent event increases 2.6-fold. New treatments have emerged as viable treatment alternatives to warfarin for stroke risk reduction in secondary prevention populations. This analysis sought to assess the cost-effectiveness of left atrial appendage closure (LAAC) compared with warfarin and the non\u2013vitamin K antagonist oral anticoagulants dabigatran 150 mg, apixaban and rivaroxaban in the prevention of stroke in nonvalvular atrial fibrillation patients with a prior stroke or transient ischemic attack.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>\n              A Markov model was constructed using data from the secondary prevention subgroup analyses of the non\u2013vitamin K antagonist oral anticoagulant and LAAC pivotal trials. Costs were from 2016 US Medicare reimbursement rates and the literature. The cost-effectiveness analysis was conducted from a US Medicare perspective over a lifetime (20 years) horizon. The model was populated with a cohort of 10\u2009000 patients aged 70 years with a CHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc score of 7 (annual stroke risk=9.60%) and HAS-BLED score of 3 (annual bleeding risk=3.74%).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>LAAC achieved cost-effectiveness relative to dabigatran at year 5 and warfarin and apixaban at year 6. At 10 years, LAAC had more quality-adjusted life years (4.986 versus 4.769, 4.869, 4.888, and 4.810) and lower costs ($42\u2009616 versus $53\u2009770, $58\u2009774, $55\u2009656, and $58\u2009655) than warfarin, dabigatran, apixaban, and rivaroxaban, respectively, making LAAC the dominant (more effective and less costly) stroke risk reduction strategy. LAAC remained the dominant strategy over the lifetime analysis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Upfront procedure costs initially make LAAC higher cost than warfarin and the non\u2013vitamin K antagonist oral anticoagulants, but within 10 years, LAAC delivers more quality-adjusted life years and has lower total costs, making LAAC the most cost-effective treatment strategy for secondary prevention of stroke in atrial fibrillation.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.117.018825","type":"journal-article","created":{"date-parts":[[2018,5,8]],"date-time":"2018-05-08T09:05:16Z","timestamp":1525770316000},"page":"1464-1470","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":40,"title":["Cost-Effectiveness of Left Atrial Appendage Closure With the WATCHMAN Device Compared With Warfarin or Non\u2013Vitamin K Antagonist Oral Anticoagulants for Secondary Prevention in Nonvalvular Atrial Fibrillation"],"prefix":"10.1161","volume":"49","author":[{"given":"Vivek Y.","family":"Reddy","sequence":"first","affiliation":[{"name":"From the Icahn School of Medicine at Mount Sinai Medical Center, New York, NY (V.Y.R.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald L.","family":"Akehurst","sequence":"additional","affiliation":[{"name":"BresMed, Sheffield, United Kingdom (R.L.A.)"},{"name":"School of Health and Related Research, University of Sheffield, United Kingdom (R.L.A.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stacey L.","family":"Amorosi","sequence":"additional","affiliation":[{"name":"Health Economics Center of Excellence, Boston Scientific, Marlborough, MA (S.L.A.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meghan B.","family":"Gavaghan","sequence":"additional","affiliation":[{"name":"Market Access, GfK, Waltham, MA (M.B.G., D.S.H.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deanna S.","family":"Hertz","sequence":"additional","affiliation":[{"name":"Market Access, GfK, Waltham, MA (M.B.G., D.S.H.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"David R.","family":"Holmes","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.R.H.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq278"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)03487-3"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(93)92358-Z"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-12-200706190-00007"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0905561"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009638"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1107039"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/0003-4975(95)00887-X"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)00396-8"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61343-X"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.114389"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.000402"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.09.084"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.111.641027"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31826d5fe8"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1586\/14737167.8.2.165"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(10)70274-X"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(12)70042-X"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(12)70092-3"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011258"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.10-0134"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2004.01.006"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1994.00420130036007"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000080678.09344.8D"},{"key":"e_1_3_4_26_2","unstructured":"Office of the Chief Actuary Social Security Administration. 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