Comparative Costs to Medicare and Medicare Beneficiaries of Alternative AF Stroke Risk Reduction Strategies

Abstract

Vivek Y Reddy,1 Yue Zhong,2 Alysha M McGovern,2 Stacey L Amorosi,2 Meghan B Gavaghan,3 Deanna S Hertz,3 Kaywei Low,3 Scott Freeman,3 David R Holmes Jr4 1Icahn School of Medicine at Mount Sinai, New York, NY, USA; 2Health Economics and Market Access, Boston Scientific, Marlborough, MA, USA; 3Ipsos Healthcare, New York, NY, USA; 4Mayo Clinic, Rochester, MN, USACorrespondence: Vivek Y Reddy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1030, New York, NY, 10029, USA, Tel [phone], Fax [phone], Email [email protected]: As healthcare costs are increasingly being shifted from payers to patients, it is important to understand the economic consequences of therapeutic strategies to both payers and patients.Objective: To determine the relative costs to Medicare and Medicare beneficiaries (patients) of warfarin, non-vitamin K oral anticoagulants (NOACs), and left atrial appendage closure (LAAC) for stroke risk reduction in nonvalvular atrial fibrillation.Methods: An economic model was developed to assess costs at 5 and 10 years. For warfarin and NOACs, inputs were derived from published meta-analyses; for LAAC with the Watchman device, inputs were derived from pooled 5-year PROTECT AF and PREVAIL trial results. The model captured therapy costs vs clinical event costs, including procedural complications and follow-up clinical outcomes. Costs were based on 2023 Medicare reimbursement and copayment rates.Results: At 10 years, overall LAAC costs ($48,337) were lower than those of NOACs ($81,198) and warfarin ($52,359). Overall LAAC costs were lower than those of NOACs by year 5 and warfarin by year 9. At 5 years, patient LAAC costs were lowest at $4,764, compared to $7,146 and $6,453 for NOACs and warfarin, respectively. LAAC patient costs were lower than those of NOACs by year 3 and warfarin by year 4. Clinical events comprised 96% of overall warfarin costs vs 48% for LAAC and 40% for NOACs.Conclusion: LAAC yielded the lowest overall and patient costs. Warfarin costs were largely driven by clinical events, which may represent an unplanned financial burden for patients. These considerations should be incorporated into shared decision-making discussions about stroke prophylaxis strategies.Keywords: economic analysis, medicare, patient, warfarin, NOACs, watchman

Keywords

• economic analysis
• medicare
• patient
• warfarin
• noacs
• watchman