ObjectiveTo assess the health effectiveness, cost and cost effectiveness of different oral anticoagulation (OAT) therapies in China, including warfarin plus international normalized ratio (INR) test in hospital labs (Lab test), warfarin plus patient self-management (PSM) with point of care device, and novel anticoagulant (Dabigatran) alone. MethodsA Markov model containing four states (no complication, hemorrhagic event, thrombotic event and death) was developed to account for long-term cost and outcomes of warfarin/novel anticoagulant users including atrial fibrillation patients and deep venous thrombosis patients. Direct medical cost was taken into consideration, covering expenses of drugs, OAT monitoring and complication management. Both clinical and cost parameters were mainly derived from literatures. ResultsCompared with hospital lab test, the PSM pattern obtained a prolonged 8.48 years and 5.08 QALYs with the larger amount of cost, CNY 47 482. The incremental cost-effectiveness ratio (ICER) of PSM versus hospital lab test came to CNY 19 240 per QALY gained, lower than GDP China per capita in 2014 (CNY 46 628). And the novel anticoagulant pattern was dominated by PSM pattern due to shortened QALYs while increased cost. The sensitivity analysis demonstrated the results were not sensitive to main indicators, including utility in different health status, complication probability, and disease management cost. ConclusionPSM can generate more QALYs by reducing the risk of major thrombotic and bleeding events with acceptable incremental cost, which turns to be the most cost effective way among the 3 patterns and demonstrates promising future in OAT management.
ObjectiveTo evaluate the performance and safety of a novel device for left atrial appengdage (LAA) closure in dogs. MethodsThrough the fourth left intercostal, the LAA clips were implanted at the base of LAA in six dogs. Macroscopic pathology, histopathology and biological detection were performed at 7 d, 60 d, 90 d, 180 d after implan-tation respectively. ResultsThe devices were all successfully implanted at the base of LAA. There is no transposition of the LAA clips. Complete fibrosis and atrophy of LAA occurred at 60 d after implantation. LAA closure was completed with a new endothelial tissue layer developed on the occluded orifice of the left atrium after 60 d after implantation. The level of atrial natriuretic peptide did not decrease significantly after the device implantation (275.64±60.00 pg/ml vs. 248.34±56.10 pg/ml, P=0.529). ConclusionThe novel device for LAA closure achieved easy, reliable and safe closure of the LAA in canine model.