Mount Sinai’s Dr. Vivek Reddy Demonstrates Cost-Effectiveness of Watchman Device
The WATCHMAN™ Left Atrial Appendage Closure Device is more cost-effective than warfarin and non-warfarin oral anticoagulants (NOACs) for stroke reduction in patients with non-valvular atrial fibrillation, according to a study led by Vivek Reddy, MD, Director of Cardiac Arrhythmia Services for The Mount Sinai Hospital and the Mount Sinai Health System, and published online and in the December 22 issue of the Journal of American College of Cardiology (JACC), the world’s leading peer-reviewed journal on cardiovascular disease.
Atrial fibrillation, a heart rhythm malfunction that affects nearly six million Americans, puts patients at a significantly greater risk of stroke, which can be both debilitating and costly. With nearly $8 billion spent annually on atrial fibrillation-associated strokes, researchers aimed to determine the cost effectiveness of three atrial fibrillation treatments: warfarin, NOACs and the WATCHMAN device.
“By its very nature, the WATCHMAN device is not subject to patient adherence issues, since once implanted, the device provides lifelong stroke prophylaxis without the risk of complications associated with blood thinners,” said Dr. Reddy. “This is crucial both in improving patient outcomes by reducing disabling strokes, as well as reducing health care costs.”
Blood-thinning medications like warfarin and NOACs have long been the standard of care for reducing the risk for stroke in patients with atrial fibrillation; however, many patients cannot tolerate these medications because of the incidence of bleeding and need for bi-weekly blood tests. While these therapies have been demonstrated to be efficacious, their effectiveness is contingent upon patient adherence, as gaps in treatment can lead to stroke.
The WATCHMAN device, approved by the U.S. Food and Drug Administration in March 2015, is implanted into the heart to close off the left atrial appendage, a blind pouch of heart tissue where blood clots form and can then break off and travel in the bloodstream to the brain and cause strokes. It is inserted through a vein in the leg during a one-time, minimally invasive, catheter-based procedure in the Electrophysiology Laboratory.
Researchers used a Markov model constructed from the perspective of the Centers for Medicare & Medicaid Services (CMS) with a lifetime horizon defined as 20 years and 3-month cycle length to evaluate the cost effectiveness of the three treatment strategies. Cost effectiveness was assessed annually to determine if there was an observable time horizon over which treatment options reached accepted levels of cost effectiveness.
The researchers found:
- The WATCHMAN device achieved cost effectiveness relative to warfarin at seven years ($42,994/QALY) and NOACs achieved cost effectiveness relative to warfarin at 16 years ($48,446/QALY) when assessing Medicare beneficiaries over a 20-year period.
- The WATCHMAN device became dominant (more effective and less costly) to warfarin at 10 years and dominant to NOACs at five years, with cost savings generated annually thereafter.
The WATCHMAN device, made by Boston Scientific, is approved in more than 70 countries worldwide. Mount Sinai experts were the first to use the device in the eastern United States.
Dr. Reddy served as co-principal investigator for national clinical trials testing the WATCHMAN device, and has served as a consultant to Boston Scientific.
About the Mount Sinai Health System
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, over 400 outpatient practices, nearly 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is one of three medical schools that have earned distinction by multiple indicators: It is consistently ranked in the top 20 by U.S. News & World Report's "Best Medical Schools," aligned with a U.S. News & World Report "Honor Roll" Hospital, and top 20 in the nation for National Institutes of Health funding and top 5 in the nation for numerous basic and clinical research areas. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.