Retrospective study of total healthcare costs associated with chronic nonvalvular atrial fibrillation and the occurrence of a first transient ischemic attack, stroke or major bleed

Abstract

Post-AF total direct healthcare costs were 3 times greater than pre-AF costs. For those with a TIA, IS or MB, post-AF total direct healthcare costs increased 4.5 times from pre-AF costs; overall post-event costs in this cohort increased approximately 25% over pre-event costs. Nearly half of the events occurred within 1 month of a claim associated with an AF diagnosis. Warfarin exposure appeared to be associated with lower pmpm costs in this population.

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

“…In the analyses conducted by Boccuzzi et al (2009), the total direct costs associated with nonvalvular AF and the occurrence of cerebrovascular events (transient ischemic attack, ischemic stroke, or major bleed) were found to be less in AF patients who received warfarin (ranging from $2,220 to $2,235 PPPM) than those who did not (ranging from $2,722 to $3,135 PPPM). 44 Translated to 1-year costs, AF patients who received warfarin (2005) indicate that if 50% of the 2.2 million persons in the United States with AF received warfarin, the costs of monitoring warfarin therapy would exceed $300 million annually.…”

“…44 Translated to 1-year costs, AF patients who received warfarin (2005) indicate that if 50% of the 2.2 million persons in the United States with AF received warfarin, the costs of monitoring warfarin therapy would exceed $300 million annually. 29 Another cost of regular laboratory monitoring to consider is the cost to patients, such as the cost of transportation and time lost from work.…”

“…A diagnosis of AF dramatically increased the total direct health care costs per patient, mainly as a result of complications, in a retrospective, observational cohort study of 3,891 patients in a large managed care organization in the United States between 2000 and 2002. 44 This study found that the total direct health care costs per member per month (PMPM) increased from $412 to $1,235 following the diagnosis of chronic nonvalvular AF. The total direct costs of a cerebrovascular event (transient ischemic attack, ischemic stroke, or major bleed) increased from a range of $392 to $567 PMPM to a range of $1,059 to $2,593 PMPM following the diagnosis of AF.…”

“…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).…”

“…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). 46 The burden of AF-related stroke is estimated at nearly $8 billion, with $2.6 billion in the year of the event itself and $5.4 billion in subsequent years.…”