ANALYZING THE BUDGET IMPACT OF NEW ORAL ANTICOAGULANTS AND ENDOVASCULAR LEFT ATRIAL AURICULAR CLOSURE IN PATIENTS WITH ATRIAL FIBRILLATION

Highlights This study is the first in Russian Federation to evaluate the impact of left atrial appendage closure (LAAC) on the healthcare budget based on real clinical data. The work demonstrates the clinical and economic advantages of LAAC over conventional anticoagulant therapy in patients at high risk of complications. Aim. To evaluate the clinical and cost-effectiveness of left atrial appendage closure (LAAC) compared with novel oral anticoagulants (NOAC) on the basis of real patient data, and to perform a scenario analysis of the impact of these approaches on the healthcare budget in the Russian Federation. Methods. The study included 145 patients divided into two groups: LAAC (n = 46) and NOAC (n = 99). The mean age was 65.5 ± 8.1 years in the LAA closure group and 67 ± 7.0 years in the NOAC group. Patients with LAA closure had a higher risk of thromboembolic and haemorrhagic complications. Direct medical costs were estimated based on the cost of procedures, drugs, and complications. Budget impact analyses were performed over a 5- and 10-year horizon, taking into account a 29% increase in the use of LAAC each year. Results. LAAC provides higher survival (95.7% vs. 79.8%) and complication-free survival (74.0% vs. 60.6%) compared to NOAC. Direct treatment costs are 405,754 RUB per patient for LAAC and 10,116 RUB for NOAC. Scenario analysis showed that over 10 years, if the share of LAA closure increases, costs will increase from 900.344 RUB billion to 920.516 billion RUB. The difference between the scenarios was 2.017 billion RUB, indicating an increase in the economic burden when the technology is scaled up. Conclusion. LAA closure is a clinically effective strategy with the potential for cost-effectiveness in the long term. It can be recommended for patients at high risk of stroke, in case of limited healthcare resources. However, successful implementation of the technology requires additional training of specialists and quality control of procedures.