Cost-effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation: a systematic review appraising the methodological quality
Abstract Background The 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 alloc...
| Principais autores: | , , , , , , , |
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| Formato: | Artigo |
| Idioma: | English |
| Publicado em: |
BMC
2023-10-01
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| coleção: | Cost Effectiveness and Resource Allocation |
| Assuntos: | |
| Acesso em linha: | https://doi.org/10.1186/s12962-023-00486-0 |
| _version_ | 1827634089943891968 |
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| author | Sumudu A. Hewage Rini Noviyani David Brain Pakhi Sharma William Parsonage Steven M. McPhail Adrian Barnett Sanjeewa Kularatna |
| author_facet | Sumudu A. Hewage Rini Noviyani David Brain Pakhi Sharma William Parsonage Steven M. McPhail Adrian Barnett Sanjeewa Kularatna |
| author_sort | Sumudu A. Hewage |
| collection | DOAJ |
| description | Abstract Background The 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. Methods We 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. Results In 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. Conclusions While 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. |
| first_indexed | 2024-03-09T15:09:30Z |
| format | Article |
| id | doaj.art-1facea0577094b42b0ff393e8cd79f9e |
| institution | Directory Open Access Journal |
| issn | 1478-7547 |
| language | English |
| last_indexed | 2024-03-09T15:09:30Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Cost Effectiveness and Resource Allocation |
| spelling | doaj.art-1facea0577094b42b0ff393e8cd79f9e2023-11-26T13:27:30ZengBMCCost Effectiveness and Resource Allocation1478-75472023-10-0121111510.1186/s12962-023-00486-0Cost-effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation: a systematic review appraising the methodological qualitySumudu A. Hewage0Rini Noviyani1David Brain2Pakhi Sharma3William Parsonage4Steven M. McPhail5Adrian Barnett6Sanjeewa Kularatna7Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of TechnologyDepartment of Pharmacy, Udayana UniversityAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of TechnologyAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of TechnologyAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of TechnologyAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of TechnologyAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of TechnologyAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of TechnologyAbstract Background The 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. Methods We 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. Results In 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. Conclusions While 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.https://doi.org/10.1186/s12962-023-00486-0Methodological qualityCost-effectivenessLeft atrial appendage closureLeft atrial appendage occlusionOral anticoagulantsNovel oral anticoagulants |
| spellingShingle | Sumudu A. Hewage Rini Noviyani David Brain Pakhi Sharma William Parsonage Steven M. McPhail Adrian Barnett Sanjeewa Kularatna Cost-effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation: a systematic review appraising the methodological quality Cost Effectiveness and Resource Allocation Methodological quality Cost-effectiveness Left atrial appendage closure Left atrial appendage occlusion Oral anticoagulants Novel oral anticoagulants |
| title | Cost-effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation: a systematic review appraising the methodological quality |
| title_full | Cost-effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation: a systematic review appraising the methodological quality |
| title_fullStr | Cost-effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation: a systematic review appraising the methodological quality |
| title_full_unstemmed | Cost-effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation: a systematic review appraising the methodological quality |
| title_short | Cost-effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation: a systematic review appraising the methodological quality |
| title_sort | cost effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation a systematic review appraising the methodological quality |
| topic | Methodological quality Cost-effectiveness Left atrial appendage closure Left atrial appendage occlusion Oral anticoagulants Novel oral anticoagulants |
| url | https://doi.org/10.1186/s12962-023-00486-0 |
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