Direct treatment cost of atrial fibrillation in the elderly American population: a Medicare perspective

Lee, Won Chan; Lamas, Gervasio A.; Balu, Sanjeev; Spalding, James; Wang, Qin; Pashos, Chris L.

doi:10.3111/13696990802063425

Cited by 96 publications

(75 citation statements)

References 31 publications

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“…On the basis of another analysis from 2008, Lee et al reported that the incremental direct treatment costs for Medicare beneficiaries with AF were higher than previously reported, partly because of the significantly higher proportion of these patients experiencing strokes and congestive heart failure 10. Extrapolating these data from a random 5% national sample of Medicare beneficiaries to the entire Medicare population results in a projected annual cost of $15.7 billion for the treatment for newly diagnosed AF 10.…”

Section: Discussionmentioning

confidence: 98%

“…Hospitalizations related to AF increased >2.4‐fold from 1985 to 1999,8 and by an additional 23% in the past decade,9 contributing to the increasing costs associated with AF over the years. The annual cost of AF treatment was estimated to be $6.65 billion in 2005,7 and later estimates were even higher 10. Intervention programs at the emergency department (ED) level have been investigated and successfully implemented in some academic centers in recent years to reduce the hospitalization rates for AF and their associated costs 11, 12, 13, 14, 15…”

Section: Introductionmentioning

confidence: 99%

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Emergency Department Visits for Atrial Fibrillation in the United States: Trends in Admission Rates and Economic Burden From 2007 to 2014

Rozen

Hosseini

Kaadan

et al. 2018

JAHA

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BackgroundAtrial fibrillation (AF) is an increasingly prevalent public health problem and one of the most common causes of emergency department (ED) visits. We aimed to investigate the trends in ED visits and hospital admissions for AF.Methods and ResultsThis is a repeated cross‐sectional analysis of ED visit‐level data from the Nationwide Emergency Department Sample for 2007 to 2014. We identified adults who visited EDs in the United States, with a principal diagnosis of AF. A sample of 864 759 ED visits for AF, representing a weighted total of 3 886 520 ED visits, were analyzed. The annual ED visits for AF increased by 30.7% from 411 406 in 2007 (95% confidence interval, 389 819–432 993) to 537 801 (95% confidence interval, 506 747–568 855) in 2014. Patient demographics remained consistent, with an average age of 69 to 70 years and slight female predominance (51%–53%) throughout the study period. Hospital admission rates were stable at ≈70% between 2007 and 2010, after which they gradually declined to 62% in 2014 (P trend=0.017). Despite the decline in hospital admission rates, AF hospitalizations increased from 288 225 in 2007 to 333 570 in 2014 because of the increase in total annual ED visits during the study. The adjusted annual charges for admitted AF patients increased by 37% from $7.39 billion in 2007 to $10.1 billion in 2014.ConclusionsAnnual ED visits and hospital admissions for AF increased significantly between 2007 and 2014, despite a reduction in admission rates. These data emphasize the need for widespread implementation of effective strategies aimed at improving the management of patients with AF to reduce hospital admissions and the economic burden of AF.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Emergency Department Visits for Atrial Fibrillation in the United States: Trends in Admission Rates and Economic Burden From 2007 to 2014

Rozen

Hosseini

Kaadan

et al. 2018

JAHA

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“…33 Analyses of managed care databases indicate that AF patients who experienced a stroke had increased annual direct costs (range $23,143 to $37,620) relative to AF patients who did not experience a stroke ($10,380 to $15,888). 15,16,44 Of AF patients who experienced a stroke or other cerebrovascular event, those who received warfarin had lower direct costs ($26,640-$26,820) than AF patients who did not receive warfarin ($32,664-$37,620). 44 Cost-effectiveness models estimate the cost of stroke in AF patients to range from $68,039 (for perfect warfarin use) to $87,248 (for approximated routine practice where a proportion of warfarin-eligible patients are prescribed aspirin or neither warfarin nor aspirin).…”

Section: The Cost Of Stroke In Patients With Afmentioning

confidence: 99%

“…15 Each patient was matched with an age-, sex-, and race-matched control. The mean incremental cost of treating AF was $16,311 (standard deviation [SD] $25,391) in the 1-year post-index period for a patient with AF compared with a patient without AF (adjusted for additional confounders, $14,199, 95% CI $13,201-15,001).…”

Section: What Is Already Known About This Subjectmentioning

confidence: 99%

“…Annual inpatient costs range from $7,841 to $22,582 per patient. [14][15][16][17]24 Estimates of ICER for new oral anticoagulants (i.e., dabigatran) ranged from $12,386 to $86,000 per QALY gained with dabigatran versus warfarin. An analysis of 600 adult patients with nonvalvular AF in the United States receiving warfarin at 1 of 3 anticoagulation clinics between 1996 and 1998 was performed.…”

Section: ■■ Design Overall Costs Of Af To Health Care Systemsmentioning

confidence: 99%

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Cost Implications of Formulary Decisions on Oral Anticoagulants in Nonvalvular Atrial Fibrillation

Biskupiak¹,

Ghate²,

Jiao³

et al. 2013

JMCP

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In the European Union, 4.5 million people are estimated to have AF.2 Patients with untreated AF are at a 4-to 5-fold increased risk of stroke compared with those without the disease. Vitamin K antagonists (VKAs), such as warfarin, have been successfully used for many years to provide prophylaxis against stroke in patients with AF. A large meta-analysis of randomized trials showed that adjusted-dose warfarin reduced the incidence of stroke by 64%. 4 However, in a real-world analysis of Medicare patients with AF, the reduction in stroke with warfarin was lower than in the meta-analysis, at 27%. 5While effective, VKAs are associated with a number of limitations: they have numerous drug and food interactions; their effect is influenced by genetic factors; and they have a narrow therapeutic range, requiring frequent international normalized ratio (INR) monitoring and dose adjustments.6 As a result of these factors, there is considerable variability in the amount of time patients spend within the therapeutic range (INR, 2.0-3.0), which exposes them to stroke when they are below the range and bleeding when they are above the range.New anticoagulants have been developed to reduce the risk of stroke in patients with AF. These oral agents are direct inhibitors of single coagulation factors and include dabigatran, rivaroxaban, and apixaban.7 They meet the need for predictable anticoagulation with fixed dosing, without the need for laboratory monitoring. As may be expected, these anticoagulants are more expensive per unit than warfarin.7 However, the

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Association Between Atrial Fibrillation and Costs After Myocardial Infarction: A Community Study

Borah

Roger

Mills

et al. 2015

Clinical Cardiology

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Objective To estimate incremental economic impact of atrial fibrillation (AF) and the timing of its onset in myocardial infarction (MI) patients. Patients and Methods This retrospective cohort study included incident MI patients from Olmsted County, Minnesota, treated between 11/1/2002 and 12/31/2010. We compared inflation-adjusted standardized costs accumulated between incident MI and end of follow-up among 3 groups by AF status and its timing: no AF, new-onset AF (within 30 days after index MI), or prior AF. Multivariate adjustment of median costs accounted for right-censoring in costs. Results The final study cohort had 1,389 patients with 989 in no AF, 163 in new-onset AF, and 237 in prior AF categories. Median follow-up times were 3.98, 3.23, and 2.55 years, respectively. Mean age at index was 67 years, with significantly younger patients in no-AF group (64 years vs 76 and 77 years, respectively; P<.001). New-onset and prior AF patients had more comorbid conditions (hypertension, heart failure, and chronic obstructive pulmonary disease). After accounting for differences in baseline characteristics, we found adjusted median (95% CI) costs of $73,000 ($69,000–$76,000) for no AF; $85,000 ($81,000–$89,000) for new-onset AF; and $97,000 ($94,000–$100,000) for prior AF. Inpatient costs composed the largest share of total median costs (no AF, 82%; new-onset AF, 84%; and prior AF, 83%). Conclusion These findings indicate that AF frequently coexists with MI and imposes incremental costs, mainly attributable to inpatient care. AF timing matters as prior AF was found to be associated with higher costs than new-onset AF.

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Direct treatment cost of atrial fibrillation in the elderly American population: a Medicare perspective

Abstract: Mean incremental direct treatment costs for Medicare beneficiaries with AF were higher than previously reported. Interventions that can reduce the incidence of AF and its complications may also reduce the national economic impact of AF.

Cited by 96 publications

References 31 publications

Emergency Department Visits for Atrial Fibrillation in the United States: Trends in Admission Rates and Economic Burden From 2007 to 2014

Emergency Department Visits for Atrial Fibrillation in the United States: Trends in Admission Rates and Economic Burden From 2007 to 2014

Cost Implications of Formulary Decisions on Oral Anticoagulants in Nonvalvular Atrial Fibrillation

Association Between Atrial Fibrillation and Costs After Myocardial Infarction: A Community Study

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