{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T10:55:57Z","timestamp":1781607357607,"version":"3.54.5"},"reference-count":71,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Left atrial appendage occlusion (LAAO) requires a significant upfront investment, which is in contrast with the more gradual, long-term costs of direct oral anticoagulants (DOACs). Objective: We performed a budget impact analysis exploring the financial impact of increasing the number of LAAO procedures in a high-stroke-risk population over a 10-year time horizon from the perspective of the healthcare providers under the Italian National Healthcare Service. Methods: Two alternative scenarios simulating an increased uptake of the LAAO therapy were compared to the estimated volume of LAAO procedures performed (baseline scenario: 1341 procedures): (1) Alternative Scenario I (3314 procedures) based on the level of penetration observed in the Italian region performing the highest rate of LAAO procedures; (2) Alternative Scenario II (7672 procedures): LAAO therapy uptake set to attain 5% of the estimated target population. Clinical data were extracted from a propensity-matched, multicenter cohort of 554 AF patients at a very high thromboembolic risk profile (CHA2DS2-VASc score \u2265 5) treated with LAAO or DOACs. Results: Cumulative cost savings in Alternative Scenario I were around \u20ac4.9 million compared to the baseline. When comparing Scenario II to the baseline scenario, savings added up to \u20ac15.8 million over 10 years. The break-even point occurred between the seventh and eighth years. Cost savings were observed even in the instance that all DOAC prices would decrease as generics became available. Conclusions: The widespread use of LAAO therapies in a population of AF patients at very high stroke risk may yield substantial long-term benefits, as the initial investment in the LAAO procedure and device would be counterbalanced within 8 years.<\/jats:p>","DOI":"10.3390\/jcm15103687","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:17:42Z","timestamp":1778519862000},"page":"3687","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Left Atrial Appendage Occlusion Versus Direct Oral Anticoagulation in Atrial Fibrillation Patients at Very High Risk of Stroke: A Budget Impact Analysis in Italy"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9883-0114","authenticated-orcid":false,"given":"Michele","family":"Magnocavallo","sequence":"first","affiliation":[{"name":"Arrhythmology Unit, Isola Tiberina-Gemelli Isola Hospital, 00186 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9560-4188","authenticated-orcid":false,"given":"Ahmad","family":"Awada","sequence":"additional","affiliation":[{"name":"Department of Cardiology, CHU Brugmann, Universit\u00e9 Libre de Bruxelles, 1020 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9157-5181","authenticated-orcid":false,"given":"Guccio","family":"Vagnarelli","sequence":"additional","affiliation":[{"name":"Boston Scientific, 20134 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8930-5609","authenticated-orcid":false,"given":"Pietro","family":"Rossi","sequence":"additional","affiliation":[{"name":"Arrhythmology Unit, Isola Tiberina-Gemelli Isola Hospital, 00186 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4005-6535","authenticated-orcid":false,"given":"Ilaria","family":"Giabbani","sequence":"additional","affiliation":[{"name":"Boston Scientific, 20134 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9334-3800","authenticated-orcid":false,"given":"Elisa","family":"Vireca","sequence":"additional","affiliation":[{"name":"Boston Scientific, 1831 Diegem, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1120-0492","authenticated-orcid":false,"given":"Giampaolo","family":"Vetta","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel\u2014Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Almorad","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel\u2014Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Chiricolo","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0078-9393","authenticated-orcid":false,"given":"Antonio","family":"Sorgente","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel\u2014Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"de Asmundis","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel\u2014Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian-Battista","family":"Chierchia","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel\u2014Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Bianchi","sequence":"additional","affiliation":[{"name":"Arrhythmology Unit, Isola Tiberina-Gemelli Isola Hospital, 00186 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Natale","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, 00133 Rome, Italy"},{"name":"Texas Cardiac Arrhythmia Institute, St. David\u2019s Medical Center, Austin, TX 78705, USA"},{"name":"Interventional Electrophysiology, Scripps Clinic, San Diego, CA 92037, USA"},{"name":"Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3837-3462","authenticated-orcid":false,"given":"Domenico Giovanni","family":"Della Rocca","sequence":"additional","affiliation":[{"name":"Department of Cardiology, CHU Brugmann, Universit\u00e9 Libre de Bruxelles, 1020 Brussels, Belgium"},{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel\u2014Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1090 Brussels, Belgium"},{"name":"Texas Cardiac Arrhythmia Institute, St. David\u2019s Medical Center, Austin, TX 78705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1161\/CIRCULATIONAHA.113.005119","article-title":"Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study","volume":"129","author":"Chugh","year":"2014","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery 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