Comparative Costs to Medicare and Medicare Beneficiaries of Alternative AF Stroke Risk Reduction Strategies.
Autor: | Reddy VY; Icahn School of Medicine at Mount Sinai, New York, NY, USA., Zhong Y; Health Economics and Market Access, Boston Scientific, Marlborough, MA, USA., McGovern AM; Health Economics and Market Access, Boston Scientific, Marlborough, MA, USA., Amorosi SL; Health Economics and Market Access, Boston Scientific, Marlborough, MA, USA., Gavaghan MB; Ipsos Healthcare, New York, NY, USA., Hertz DS; Ipsos Healthcare, New York, NY, USA., Low K; Ipsos Healthcare, New York, NY, USA., Freeman S; Ipsos Healthcare, New York, NY, USA., Holmes DR Jr; Mayo Clinic, Rochester, MN, USA. |
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Jazyk: | angličtina |
Zdroj: | ClinicoEconomics and outcomes research : CEOR [Clinicoecon Outcomes Res] 2024 Feb 14; Vol. 16, pp. 81-96. Date of Electronic Publication: 2024 Feb 14 (Print Publication: 2024). |
DOI: | 10.2147/CEOR.S440556 |
Abstrakt: | Background: 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. Competing Interests: Dr. Reddy, Ms. Gavaghan, Ms. Hertz, Ms. Low, and Mr. Freeman are paid consultants to Boston Scientific. Dr. Reddy has also received grant support from Boston Scientific during the conduct of the study. He has served as a consultant for and has equity in Ablacon, Acutus Medical, Affera-Medtronic, Anumana, Apama Medical-Boston Scientific, APN Health, Aquaheart, Atacor, Autonomix, Axon Therapies, Backbeat, BioSig, CardiaCare, CardioNXT / AFTx, Circa Scientific, CoRISMA, Corvia Medical, Dinova-Hangzhou DiNovA EP Technology, East End Medical, EPD-Philips, EP Frontiers, Epix Therapeutics-Medtronic, EpiEP, Eximo, Farapulse-Boston Scientific, Field Medical, Focused Therapeutics, HRT, Intershunt, Javelin, Kardium, Keystone Heart, Laminar, LuxMed, Medlumics, Middlepeak, Nuvera-Biosense Webster, Oracle Health, Restore Medical, Sirona Medical, SoundCath, Valcare; unrelated to this work, has served as a consultant for Abbott, Adagio Medical, AtriAN, Biosense-Webster, BioTel Heart, Biotronik, Cairdac, Cardiofocus, Cardionomic, CoreMap, Fire1, Gore & Associates, Impulse Dynamics, Medtronic, Novartis, Novo Nordisk, Philips, Pulse Biosciences; and has equity in DRS Vascular, Manual Surgical Sciences, Newpace, Nyra Medical, Surecor, and Vizaramed, outside the submitted work. At the time of writing, Dr. Zhong and Ms. Amorosi were full-time employees of Boston Scientific. Ms. McGovern is a full-time employee of Boston Scientific. Dr. Holmes Jr has no relevant disclosures to report for this work. (© 2024 Reddy et al.) |
Databáze: | MEDLINE |
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