期刊论文详细信息
Cost Effectiveness and Resource Allocation
Cost-effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation: a systematic review appraising the methodological quality
Research
Adrian Barnett1  Pakhi Sharma1  Sanjeewa Kularatna1  Sumudu A. Hewage1  David Brain1  William Parsonage2  Steven M. McPhail3  Rini Noviyani4 
[1] Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, No.61, Musk Avenue, 4059, Kelvin Grove, QLD, Australia;Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, No.61, Musk Avenue, 4059, Kelvin Grove, QLD, Australia;Cardiology department, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia;Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, No.61, Musk Avenue, 4059, Kelvin Grove, QLD, Australia;Digital Health and Informatics Directorate, Metro South Health, Brisbane, QLD, Australia;Department of Pharmacy, Udayana University, Bali, Indonesia;
关键词: Methodological quality;    Cost-effectiveness;    Left atrial appendage closure;    Left atrial appendage occlusion;    Oral anticoagulants;    Novel oral anticoagulants;    Warfarin;    Stroke prevention;    Atrial fibrillation;   
DOI  :  10.1186/s12962-023-00486-0
 received in 2023-03-23, accepted in 2023-10-10,  发布年份 2023
来源: Springer
PDF
【 摘 要 】

BackgroundThe increasing global prevalence of atrial fibrillation (AF) has led to a growing demand for stroke prevention strategies, resulting in higher healthcare costs. High-quality economic evaluations of stroke prevention strategies can play a crucial role in maximising efficient allocation of resources. In this systematic review, we assessed the methodological quality of such economic evaluations.MethodsWe searched electronic databases of PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Econ Lit to identify model-based economic evaluations comparing the left atrial appendage closure procedure (LAAC) and oral anticoagulants published in English since 2000. Data on study characteristics, model-based details, and analyses were collected. The methodological quality was evaluated using the modified Economic Evaluations Bias (ECOBIAS) checklist. For each of the 22 biases listed in this checklist, studies were categorised into one of four groups: low risk, partial risk, high risk due to inadequate reporting, or high risk. To gauge the overall quality of each study, we computed a composite score by assigning + 2, 0, − 1 and − 2 to each risk category, respectively.ResultsIn our analysis of 12 studies, majority adopted a healthcare provider or payer perspective and employed Markov Models with the number of health states varying from 6 to 16. Cost-effectiveness results varied across studies. LAAC displayed a probability exceeding 50% of being the cost-effective option in six out of nine evaluations compared to warfarin, six out of eight evaluations when compared to dabigatran, in three out of five evaluations against apixaban, and in two out of three studies compared to rivaroxaban. The methodological quality scores for individual studies ranged from 10 to − 12 out of a possible 24. Most high-risk ratings were due to inadequate reporting, which was prevalent across various biases, including those related to data identification, baseline data, treatment effects, and data incorporation. Cost measurement omission bias and inefficient comparator bias were also common.ConclusionsWhile most studies concluded LAAC to be the cost-effective strategy for stroke prevention in AF, shortcomings in methodological quality raise concerns about reliability and validity of results. Future evaluations, free of these shortcomings, can yield stronger policy evidence.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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Fig. 9

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