ANALYZING THE BUDGET IMPACT OF NEW ORAL ANTICOAGULANTS AND ENDOVASCULAR LEFT ATRIAL AURICULAR CLOSURE IN PATIENTS WITH ATRIAL FIBRILLATION
Dmitry V. Ognerubov,
Evgenia A. Berseneva,
Alexey E. Cheberda,
Batyr A. Zhakypov,
Vladislav V. Babchenko,
Irina A. Merkulova,
Dmitry V. Pevzner,
Nikolai A. Ognerubov,
Evgeny V. Merkulov https://doi.org/10.17802/2306-1278-2025-14-6-28-38
Abstract
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.
About the Authors
Dmitry V. Ognerubov
Federal State Budgetary Educational Institution of Higher Education “Russian Presidential Academy of National Economy and Public Administration”
Russian Federation
Russian Federation
PhD in Medical Sciences, Associate Professor, Department of Labor and Social Policy, Institute of Public Service and Management, Federal State Budgetary Educational Institution of Higher Education “Russian Presidential Academy of National Economy and Public Administration”, Moscow, Russian Federation
Evgenia A. Berseneva
Federal State Budgetary Educational Institution of Higher Education “Russian Presidential Academy of National Economy and Public Administration”;
Federal State Budgetary Educational Institution of Additional Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
PhD in Medical Sciences, Professor, Head of the Department of Health Care Organization and Quality Management, Faculty of Management in Medicine and Healthcare, Institute of Industry Management, Federal State Budgetary Educational Institution of Higher Education “Russian Presidential Academy of National Economy and Public Administration”, Moscow, Russian Federation; Professor at the Department of Medical Statistics and Informatics, Federal State Budgetary Educational Institution of Additional Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
Alexey E. Cheberda
“Center for Pharmacoeconomic Research” LLC
Russian Federation
Russian Federation
Executive Director of the “Center for Pharmacoeconomic Research” LLC, Moscow, Russian Federation
Batyr A. Zhakypov
Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” of the Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
Postgraduate Student, Department of Endovascular Methods of Diagnostics and Treatment, Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
Vladislav V. Babchenko
Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” of the Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
Resident, 2nd Department of Endovascular Methods of Diagnostics and Treatment, Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
Irina A. Merkulova
Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” of the Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
Anesthesiologists at the Intensive Care Unit № 1, Department of Cardiology, Junior Researcher at Department of Emergency Cardiology, Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
Dmitry V. Pevzner
Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” of the Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
MD, PhD in Medical Sciences, Head of Department, Chief Researcher, Department of Emergency Cardiology, Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
Nikolai A. Ognerubov
Federal State Budgetary Educational Institution of Higher Education “Derzhavin Tambov State University”
Russian Federation
Russian Federation
MD, PhD in Medical Sciences,PhD in Law, Professor, Department at the Department of Morphology, Federal State Budgetary Educational Institution of Higher Education “Derzhavin Tambov State University, Tambov, Russian Federation
Evgeny V. Merkulov
Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” of the Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
MD, PhD in Medical Sciences, Head of the 1st Department of Endovascular Methods of Diagnosis and Treatment, Senior Researcher, Federal State Budgetary Institution “National Medical Research Center of Cardiology named after Academician E.I. Chazov” of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
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Review
For citations:
Ognerubov D.V., Berseneva E.A., Cheberda A.E., Zhakypov B.A., Babchenko V.V., Merkulova I.A., Pevzner D.V., Ognerubov N.A., Merkulov E.V. ANALYZING THE BUDGET IMPACT OF NEW ORAL ANTICOAGULANTS AND ENDOVASCULAR LEFT ATRIAL AURICULAR CLOSURE IN PATIENTS WITH ATRIAL FIBRILLATION. Complex Issues of Cardiovascular Diseases. 2025;14(6):28-38. (In Russ.) https://doi.org/10.17802/2306-1278-2025-14-6-28-38
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