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Clinical and economic efficiency of endovascular left atrial appendage closure for patients with contraindication to anticoagulant
- Authors: Dmitry V.O.1, Evgenia A.B.2, Alexei E.C.3, Vladislav V.B.4, Irina A.M.4, Dmitry V.P.4, Nikolai A.O.5, Evgeny V.M.4
- Affiliations:
- Russian Presidential Academy of National Economy and Public Administration (RANEPA), Moscow, Russian Federation
- Russian Medical Academy of Continuing Professional Education (RMANPO), Moscow, Russian Federation
- LLC «Centre for Pharmacoeconomics Research», Moscow, Russian Federation
- Federal State Budgetary Institution «National Medical Research Centre of Cardiology named after Academician E. I. Chazov» of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
- Federal State Budgetary Educational Institution of Higher Education «Tambov State University named after G. R. Derzhavin» Tambov, Russian Federation
- Issue: No 3 (2025)
- Pages: 65-72
- Section: Общественное здоровье и организация здравоохранения
- URL: https://bulleten-nriph.ru/journal/article/view/2942
- DOI: https://doi.org/10.69541/NRIPH.2025.03.010
- Cite item
Abstract
Study Objective. The aim of this study was to evaluate the cost-effectiveness of percutaneous occlusion of the left atrial appendage (LAA) compared with standard stroke prevention in patients with atrial fibrillation (AF) and contraindications to oral anticoagulants (OAC) from the point of view of the Russian healthcare system. Materials and Methods: We analyzed the data of 134 patients admitted to NMIC Cardiology from 2014 to 2022, of whom 74 patients underwent ULP closure and 60 patients did not receive prophylactic treatment. Treatment costs and quality of life (QALY) scores were evaluated over 3 years. Data on complication rates, survival and complication-free survival, and direct treatment costs including hospitalisation, therapy, autopsy and funeral costs were used. Results: Over 3 years, survival was 86.5% with LAAO versus 66.3% without prophylaxis; complication-free survival was 71.6% versus 40.0%, respectively; and the incidence of ischaemic stroke was 4.1% versus 30.0%, respectively. The mean 3-year cost per patient was 461,015 RUB for LAAO and 101,365 RUB without prophylaxis; total QALYs were 2.119 and 1.665, respectively; CER was 217,563 RUB/QALY (LAAO) and 60,880 RUB/QALY (no prophylaxis). Incremental estimates after excluding non-medical costs were: ICERQALY = 826,850 RUB per QALY gained, ICER per additional survivor = 1,858,366 RUB, and ICER per additional complication-free survivor = 1,187,943 RUB. One-way sensitivity analysis (±15% on key cost and survival parameters) confirmed robustness relative to a hypothetical willingness-to-pay threshold; nevertheless, interpretation is made against a suboptimal comparator, warranting caution when extrapolating to populations in whom OAC remains feasible. Conclusions: From the perspective of the Russian healthcare system, LAAO in patients with AF and documented absolute contraindications to OAC shows clinical benefit with an acceptable incremental cost over a 3-year horizon; however, because the comparison was made against a guideline-suboptimal strategy and given the constraints of a retrospective design and sample size, prospective economic evaluations and randomized clinical trials in the target population are needed to definitively confirm the technology’s economic value
About the authors
Viktorovich Ognerubov Dmitry
Russian Presidential Academy of National Economy and Public Administration (RANEPA), Moscow, Russian Federation
Email: 001
Aleksandrovna Berseneva Evgenia
Russian Medical Academy of Continuing Professional Education (RMANPO), Moscow, Russian Federation
Email: 002
Evgen'evich Cheberda Alexei
LLC «Centre for Pharmacoeconomics Research», Moscow, Russian Federation
Email: 003
Valer'evich Babchenko Vladislav
Federal State Budgetary Institution «National Medical Research Centre of Cardiology named after Academician E. I. Chazov» of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
Email: 004
Alekseevna Merkulova Irina
Federal State Budgetary Institution «National Medical Research Centre of Cardiology named after Academician E. I. Chazov» of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
Email: 005
Vol'fovich Pevzner Dmitry
Federal State Budgetary Institution «National Medical Research Centre of Cardiology named after Academician E. I. Chazov» of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
Email: 006
Alekseevich Ognerubov Nikolai
Federal State Budgetary Educational Institution of Higher Education «Tambov State University named after G. R. Derzhavin» Tambov, Russian Federation
Email: 007
Vladimirovich Merkulov Evgeny
Federal State Budgetary Institution «National Medical Research Centre of Cardiology named after Academician E. I. Chazov» of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
Email: 008
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