The non-anticoagulation costs of atrial fibrillation management: findings from an observational study in NHS Primary Care

Abstract

Background:Atrial fibrillation (AF) management represents a significant burden on the UK NHS. Understanding this burden will be important in informing future health care planning and policy development.Aim:To describe the non-anticoagulation costs associated with AF management in routine UK clinical practice.Materials, patients and methods:A retrospective observational study of 825 patients with AF undertaken in eight UK primary care practices. Data collected from routine clinical and prescribing records of all eligible, consenting patients, for a period of up to 3 years. The first 12 weeks following diagnosis was defined as the ‘initiation phase’; the period after week 12 was defined as the ‘maintenance phase’.Results:Mean (SD) total cost of AF management was £941 (£1094) per patient in the initiation phase and £426 (£597) per patient-year in the maintenance phase. AF-related inpatient admissions contributed most to total costs; the mean (SD) total cost per patient in the initiation phase was £2285 (£900) for admitted and £278 (£252) for non-admitted patients. Mean maintenance phase costs per year were £1323 (£755) and £168 (£234), respectively, for admitted and non-admitted patients. Significant patient variables contributing to high cost in the initiation phase were hypertension and younger patient age, although only accounting for 6% of cost variability. Significant variables in the maintenance phase (18% of cost variability) were the presence of congestive heart failure, structural heart disease or diabetes and the frequency of day case admissions, ECGs and hospitalisations in the initiation phase.Conclusions:Inpatient admissions contributed most to total AF management costs. Given the burden of hospital care, future work should focus on evaluating the appropriateness and reasons for hospitalisation in patients with AF and the factors affecting length of stay, with the aim of identifying opportunities to safely reduce inpatient costs.A number of significant patient characteristics and initiation phase variables were identified, which accounted for 18% of the variability in total maintenance phase costs. However, none of these could adequately predict high maintenance phase costs.

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

“…110 Costs were available for a 12-week initialisation period and annual 'maintenance' periods thereafter, summarised in Table 39. These costs included the costs of blood testing, medication, primary and secondary care visits, further diagnostic testing and inpatient visits.…”

“…This identified 261 records, of which eight papers [99][100][101][102][103][104][105][106] not previously identified were considered relevant after title and abstract screening and a further four papers [107][108][109][110] were highlighted as providing information on costs.…”

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

“…All of the prevalence-based bottom-up studies and the incidence-based study by Lee et al calculated the cost-of-illness for the period of 1 year after index [24]. Kassianos et al calculated 1-year costs following an initiation phase of 3 months, costs incurred during this period were reported separately [47]. Furthermore, Bhave et al and Rostagno et al calculated costs that were incurred in the calendar year of index [34,43].…”

“…In the study by Kassianos et al, costs did not differ significantly between the different types of AF during the initiation of treatment. However, in the maintenance phase (at least 12 weeks after the initial diagnosis), patients with persistent AF incurred the highest costs, followed by patients with paroxysmal and permanent AF [47]. McBride et al investigated the impact of anti-arrhythmic treatment on total costs.…”