Costs of major intracranial, gastrointestinal and other bleeding events in patients with atrial fibrillation – a nationwide cohort study

Jakobsen, Marie; Kolodziejczyk, Christophe; Fredslund, Eskild Klausen; Poulsen, Peter Bo; Dybro, Lars

doi:10.1186/s12913-017-2331-z

Cited by 21 publications

(27 citation statements)

References 44 publications

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“…The attributable costs are the total costs of AF minus the total costs among the controls in accordance with previous publications [ 17 , 18 ]. Hence, attributable costs were estimated as a difference-in-difference in which the difference between costs for cases (AF patients) and controls was regarded as being attributable to the AF.…”

Section: Methodsmentioning

confidence: 92%

Cost of illness of atrial fibrillation: a nationwide study of societal impact

Johnsen

Dalby²,

Täckström³

et al. 2017

BMC Health Serv Res

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BackgroundThe prevalence of atrial fibrillation is increasing rapidly; however, to date, population-based data are lacking on the attributable cost of illness of atrial fibrillation from a societal perspective, including both direct and indirect costs.MethodsThe study was an incidence-based cost-of-illness study based on national registries covering the entire population of Denmark. We identified all patients with a first-time hospital diagnosis of atrial fibrillation between 2001 and 2012. For every atrial fibrillation patient, we identified three age- and sex-matched controls from the general population. Both the total and the attributable costs of atrial fibrillation were estimated based on individual level information on hospital care (in- and out-patient contacts), primary sector care, use of prescription drugs and productivity loss.ResultsAverage 3-year societal costs per patient attributable to atrial fibrillation were estimated to be €20,403–26,544 during the study period. The costs were highest during the first year after diagnosis of atrial fibrillation. Admission costs constituted the largest cost component, whereas primary sector costs and medicine costs only constituted minor components. The attributable costs were more than two-fold higher among patients experiencing a stroke. The total 3-year cost attributable to atrial fibrillation in Denmark was estimated to be €219–295 million.ConclusionsThe societal costs attributable to atrial fibrillation are significant. Reducing the need for hospitalizations, in particular from stroke, is a key factor in controlling the costs.

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Section: Methodsmentioning

confidence: 92%

Cost of illness of atrial fibrillation: a nationwide study of societal impact

Johnsen

Dalby²,

Täckström³

et al. 2017

BMC Health Serv Res

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“…While the absolute risk is low, oral anticoagulants remain a common cause of bleedingrelated hospitalizations. [1][2][3][4][5] In one real-world study of patients with AF who were treated with oral factor Xa inhibitors, those who were hospitalized with a major bleed of any type were found to have mean hospital stays exceeding 5 days and inpatient mortality rates of approximately 3%, though mortality risk was notably higher for patients with intracranial hemorrhage (ICH) (approximately 14%). 4 There is a scarcity of nationally representative data describing the incidence and burden-of-illness of bleeding-related hospitalizations in AF patients, both overall and by bleed subtype.…”

Section: Introductionmentioning

confidence: 99%

Burden-of-Illness Associated with Bleeding-Related Hospitalizations in Atrial Fibrillation Patients: Findings from the Nationwide Readmission Database

Miao

Miller

Lovelace

et al. 2020

TH Open

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Introduction A paucity of contemporary data examining bleeding-related hospitalization outcomes in atrial fibrillation (AF) patients exists. Methods Adults in the Nationwide Readmissions Database (January 2016–November 2016) with AF and hospitalized for intracranial hemorrhage (ICH), gastrointestinal, genitourinary, or other bleeding were identified. Association between bleed types and outcomes were assessed using multivariable regression (gastrointestinal defined as referent) and reported as crude incidences and adjusted odds ratios (ORs) or mean differences with 95% confidence intervals (CIs). Results In total, 196,878 index bleeding-related hospitalizations were identified in this AF cohort (CHA2DS2VASc score ≥2 in 95.1%), with 70.8% classified as gastrointestinal. The overall incidences of in-hospital mortality, need for post-discharge out-of-home care, and 30-day readmission were 4.9, 50.8, and 18.2%, respectively. Multivariable regression suggested traumatic and nontraumatic ICHs were associated with higher odds of in-hospital mortality (OR = 3.99, 95% CI = 3.79, 4.19; OR = 13.09, 95% CI = 12.24, 13.99) and need for post-discharge out-of-home care (OR = 2.92, 95% CI = 2.83, 3.01; OR = 2.74, 95% CI = 2.59, 2.90), and increases in mean index hospitalization length-of-stay (8.31 days, 95% CI = 8.03, 8.60, 6.27 days, 95% CI = 5.97, 6.57) versus gastrointestinal bleeding. Genitourinary and other bleeds were associated with lower mortality (OR = 0.37, 95% CI = 0.25, 0.55; OR = 0.59, 95% CI = 0.53, 0.64) and reduced length-of-stays (−2.84 days, 95% CI = − 2.91, −2.76; −2.06 days, 95% CI = − 2.11, −2.01) versus gastrointestinal bleeding. Genitourinary bleeds were also associated with a reduced need for post-discharge out-of-home care (OR = 0.86, 95% CI = 0.77, 0.97). Conclusion The burden of bleeding-related hospitalizations was notably driven by relatively rare but severe and life-threatening ICH, and less morbid but more frequent gastrointestinal bleeding. There is need for continued research on bleeding risk factors and mitigation techniques to avoid bleeding-related patient hospitalizations.

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“… 2 Several prior studies have reported that the mean costs of ischemic stroke (IS) were significantly higher for patients with AF than for those without AF. 3 , 4 , 5 , 6 Two national database studies in Europe 7 , 8 estimated the mean costs for intracranial hemorrhage, gastrointestinal bleeding, and other major bleeding events in patients with AF. The acute care costs were 7331, 3601, 3941 Euros (EUR), and the average 3-year societal costs were 27,627, 17,868, and 12,384 EUR, respectively, suggesting that bleeding events also conferred a substantial economic burden on patients with AF.…”

Section: Introductionmentioning

confidence: 99%

In‐hospital direct costs for thromboembolism and bleeding in Chinese patients with atrial fibrillation

Chang

Liu³

et al. 2018

Chronic Diseases and Translational Medicine

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ObjectiveLimited data are available on the direct costs of hospitalization owing to thromboembolism and bleeding in patients with atrial fibrillation (AF) in China. Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic strategies. This study aimed to provide detailed data regarding in-hospital direct costs for these patients, compare the costs at different scenarios, and identify independent factors that may predict the costs.MethodsWe collected data regarding in-hospital direct costs among patients with AF who were hospitalized owing to ischemic stroke (IS), transient ischemic attack (TIA), intracranial hemorrhage (ICH), or major gastrointestinal bleeding. All data were collected from 7 representative tertiary referral hospitals and 3 secondary care hospitals from December 2009 to October 2014.ResultsIn total, 312 eligible patients with thromboembolism and 143 patients with major bleeding were identified, and their hospital charts were reviewed. The median in-hospital direct costs were 17,857 Chinese Yuan (CNY) for IS and 16,589 CNY for TIA (equivalent to 2907 US dollars and 2701 US dollars, respectively). For patients with major bleeding, the costs were 27,924 CNY for ICH and 18,196 CNY for major gastrointestinal bleeding (equivalent to 4546 US dollars and 2962 US dollars, respectively). The direct costs were mainly driven by medications, which accounted for approximately 33.4%–36.1% in different groups of patients. The direct costs were highly related to the hospital level and National Institutes of Health Stroke Scale scores in patients with thromboembolism; in patients with ICH, the factors included hospital level, warfarin treatment before admission, and prior hospitalization for stroke.ConclusionsGiven the high prevalence, AF-related thromboembolism and bleeding impose considerable economic burden on the Chinese society. Efforts to improve the management of AF may confer substantial economic benefits.

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Costs of major intracranial, gastrointestinal and other bleeding events in patients with atrial fibrillation – a nationwide cohort study

Cited by 21 publications

References 44 publications

Cost of illness of atrial fibrillation: a nationwide study of societal impact

Cost of illness of atrial fibrillation: a nationwide study of societal impact

Burden-of-Illness Associated with Bleeding-Related Hospitalizations in Atrial Fibrillation Patients: Findings from the Nationwide Readmission Database

In‐hospital direct costs for thromboembolism and bleeding in Chinese patients with atrial fibrillation

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