Incidence and Cost of Stroke and Hemorrhage in Patients Diagnosed with Atrial Fibrillation in France

Cotté, François-Emery; Chaize, Gwendoline; Kachaner, I.; Gaudin, Anne-Françoise; Vainchtock, Alexandre; Durand‐Zaleski, Isabelle

doi:10.1016/j.jstrokecerebrovasdis.2013.08.022

Cited by 36 publications

(32 citation statements)

References 35 publications

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“…The cost estimates of the present study are higher than the cost estimates of existing studies as these studies have focused on hospital costs only. Cotté et al (2014) estimated the 2-years hospital costs of bleeding events in 61,582 patients with AF in France who were eligible for anticoagulation treatment based on data from the French national hospital claims system covering the period 2006-2008 [43]. Mean 2-years hospital costs per patient were 7331 EUR for intracranial haemorrhages, 3601 EUR for gastrointestinal bleeding events, and 3941 EUR for other bleeding events.…”

Section: Discussionmentioning

confidence: 99%

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

Jakobsen¹,

Kolodziejczyk²,

Fredslund³

et al. 2017

BMC Health Serv Res

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BackgroundUse of oral anticoagulation therapy in patients with atrial fibrillation (AF) involves a trade-off between a reduced risk of ischemic stroke and an increased risk of bleeding events. Different anticoagulation therapies have different safety profiles and data on the societal costs of both ischemic stroke and bleeding events are necessary for assessing the cost-effectiveness and budgetary impact of different treatment options. To our knowledge, no previous studies have estimated the societal costs of bleeding events in patients with AF.The objective of this study was to estimate the 3-years societal costs of first-incident intracranial, gastrointestinal and other major bleeding events in Danish patients with AF.MethodsThe study was an incidence-based cost-of-illness study carried out from a societal perspective and based on data from national Danish registries covering the period 2002-2012. Costs were estimated using a propensity score matching and multivariable regression analysis (first difference OLS) in a cohort design.ResultsAverage 3-years societal costs attributable to intracranial, gastrointestinal and other major bleeding events were 27,627, 17,868, and 12,384 EUR per patient, respectively (2015 prices). Existing evidence shows that the corresponding costs of ischemic stroke were 24,084 EUR per patient (2012 prices). The average costs of bleeding events did not differ between patients with AF who were on oral anticoagulation therapy prior to the event and patients who were not.ConclusionsThe societal costs attributable to major bleeding events in patients with AF are significant. Intracranial haemorrhages are most costly to society with average costs of similar magnitude as the costs of ischemic stroke. The average costs of gastrointestinal and other major bleeding events are lower than the costs of intracranial haemorrhages, but still substantial. Knowledge about the relative size of the costs of bleeding events compared to ischemic stroke in patients with AF constitutes valuable evidence for decisions-makers in Denmark as well as in other countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2331-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

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

Jakobsen¹,

Kolodziejczyk²,

Fredslund³

et al. 2017

BMC Health Serv Res

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“…Conversely, in the United Kingdom and France, although the incidence of stroke is consistent with what has been observed previously in real-life studies (0.9 and 1.2 events/100 patient-years, respectively), the incidence of hemorrhage in the present study appeared to be lower than expected from these earlier studies (3.8 and 3.2 events/100 patient-years, respectively). 43,44 This discrepancy could be attributable, at least in part, to the fact that bleeding events may be managed elsewhere than in primary care, and events that are not serious or without consequences may go undocumented.…”

Section: Discussionmentioning

confidence: 99%

Vitamin K Antagonist Treatment in Patients With Atrial Fibrillation and Time in Therapeutic Range in Four European Countries

Cotté¹,

Benhaddi²,

Duprat-Lomon³

et al. 2014

Clinical Therapeutics

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“…12,13 A recently published retrospective study estimated 2-year direct costs of up to €29 700 ($40 689). 24 However, cost comparisons across studies must be interpreted with caution because of differing methods and variability in costs compared with time and in different healthcare systems.…”

Section: Discussionmentioning

confidence: 99%

Acute Hospital, Community, and Indirect Costs of Stroke Associated With Atrial Fibrillation

Hannon

Daly

Murphy

et al. 2014

Stroke

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A trial fibrillation (AF) increases the risk of stroke, disability, dementia, and death, with a characteristic profile of more severe, disabling, and recurrent stroke compared with stroke without AF. [1][2][3][4] With aging populations, the prevalence of AF is projected to increase ≥2-fold by 2050, accompanied by an increase in the frequency of AF-associated stroke. 5 Accurate health economic data are important to inform health policy decisions to respond to this societal increase in AF prevalence, such as population screening programs. Reliable data on the cost of stroke associated with AF (AF-stroke) are also essential for rigorous cost-effectiveness studies of new oral anticoagulant agents, which guide reimbursement decisions for healthcare providers internationally. [6][7][8][9] Existing hospital-based studies have described high costs of stroke associated with AF. [10][11][12][13][14][15] However, existing studies have been limited by the reporting of acute hospital costs only, or by the inclusion of selected AF-stroke subgroups, such as hospitalized patients, nonaphasic patients, those with first-ever stroke only, or 1-year survivors. No cost studies of AF-stroke have been performed in unselected patients, including costs of community healthcare and indirect costs associated with lost productivity, leading to substantial underestimation of the Background and Purpose-No economic data from population-based studies exist on acute or late hospital, community, and indirect costs of stroke associated with atrial fibrillation (AF-stroke). Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic agents. Methods-In a population-based prospective study of incident and recurrent stroke treated in hospital and community settings, we investigated direct (healthcare related) and indirect costs for a 2-year period. Survival, disability, poststroke residence, and healthcare use were determined at 90 days, 1 year, and 2 years. Acute hospital cost was determined using a case-mix approach, and other costs using a bottom-up approach (2007 prices). Results-In 568 patients ascertained in 1 year (2006), the total estimated 2-year cost was $33.84 million. In the overall sample, AF-stroke accounted for 31% (177) of patients, but a higher proportion of costs (40.5% of total and 45% of nursing home costs). On a per-patient basis compared with non-AF-stroke, AF-stroke was associated with higher total (P<0.001) and acute hospital costs (P<0.001), and greater nursing home (P=0.001) and general practitioner (P<0.001) costs among 90-day survivors. After stratification by stroke severity in survivors, AF was associated with 2-fold increase in costs in patients with mild-moderate (National Institutes of Health Stroke Scale, 0-15) stroke (P<0.001) but not in severe stroke (National Institutes of Health Stroke Scale ≥16; P=0.7). Conclusions-In our population study, AF-stroke was associated with substantially higher total, acute hospital, nursing home, and general practitioner cos...

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Incidence and Cost of Stroke and Hemorrhage in Patients Diagnosed with Atrial Fibrillation in France

Cited by 36 publications

References 35 publications

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

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

Vitamin K Antagonist Treatment in Patients With Atrial Fibrillation and Time in Therapeutic Range in Four European Countries

Acute Hospital, Community, and Indirect Costs of Stroke Associated With Atrial Fibrillation

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