Impact of Atrial Fibrillation on Stroke‐Related Healthcare Costs

Abstract

BackgroundLimited data exist on the economic implications of stroke among patients with atrial fibrillation (AF). This study assesses the impact of AF on healthcare costs associated with ischemic stroke (IS), hemorrhagic stroke (HS), or transient ischemic attack (TIA).Methods and ResultsA retrospective analysis of MarketScan claims data (2005‐2011) for AF patients ≥18 years old with ≥1 inpatient claim for stroke, or ≥1 ED or inpatient claim for TIA as identified by ICD‐9‐CM codes who had ≥12 months continuous enrollment prior to initial stroke. Initial event‐ and stroke‐related costs 12 months post‐index were compared among patients with AF and without AF. Adjusted costs were estimated, controlling for demographics, comorbidities, anticoagulant use, and baseline resource use. Data from 23 807 AF patients and 136 649 patients without AF were analyzed. Unadjusted mean cost of the index event was $20 933 for IS, $59 054 for HS, $8616 for TIA hospitalization, and $3395 for TIA ED visit. After controlling for potential confounders, adjusted mean incremental costs (index plus 12‐month post‐index) for AF patients were higher than those for non‐AF patients by: $4726, $7824, and $1890 for index IS, HS, TIA (identified by hospitalization), respectively, and $1700 for TIA (identified by ED) (all P<0.01). In multivariate regression analysis, AF was associated with a 20% (IS), 13% (HS), and 18% (TIA) increase in total stroke‐related costs.ConclusionStroke‐related care for IS, HS, and TIA is costly, especially among individuals with AF. Reducing the risk of AF‐related stroke is important from both clinical and economic standpoints.

Cost-of-illness studies of atrial fibrillation: methodological considerations

“…Administrative data were the most common type of data analyzed. Ten studies were based on claims data from health insurance providers [23][24][25][26][27][28][29][30][31][32][33]: Medicare [23][24][25], managed care organizations (sponsored both by Medicare and commercial insurance providers) [27,30,31,33], employer-sponsored health plans [28,29] and a German sickness fund [26]. In addition, one study used billing data from a hospital [34], and two studies used data from registries [35,36].…”

“…The managed care organizations members targeted by Kim et al had an average age of 62.7 and 64 years [31,32]. Few studies stated inclusion criteria with regard to pre-existing disease, most notably, three studies included stroke patients only [33,36,42]. In addition, Amin et al [23] and Reinhold et al [26] focused on AF patients with pre-existing cardiovascular risk factors.…”

“…As administrative data are subject to coding errors, there were approaches of verifying the diagnosis of AF. Several studies required a single diagnosis of AF at an inpatient setting or more than one diagnosis at an outpatient setting [23,27,31,33], and two required at least two AF-related claims at any clinical setting [28,30]. Boccuzzi et al studied chronic AF, which was defined as at least two AF-related claims within 45 days [30].…”

“…The studies by Lee [34] or cardiac surgery [43]. In addition, Sussman et al analyzed incident cases of stroke [33]. [34].…”

Using Phase-Based Costing of Real-World Data to Inform Decision–Analytic Models for Atrial Fibrillation

“…However, the costs of AF and its complications included in existing models are typically not specific to AF patients, and are gathered from various studies of other conditions or other published decision analyses [8][9][10][11][12][13][14][15][16][17][18]. Of particular concern is that non-AF-based cost estimates may underestimate resource use and costs when compared with AF-based estimates [18,19]. Thus, the value of some interventions may be higher than traditional decision-analytic models have suggested.…”