Systematic review of societal costs associated with stroke, bleeding and monitoring in atrial fibrillation

Martin, Amber; Reeves, Alessandra Garcia; Berger, Samantha; Fusco, Manuela Di; Wygant, Gail; Savone, Mirko; Snook, Kassandra R.; Nejati, Mina; Lanitis, Tereza

doi:10.2217/cer-2019-0089

Cited by 5 publications

(3 citation statements)

References 44 publications

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“…To the best of our knowledge, currently-published studies have not evaluated the burden of indirect costs (e.g. caregiver burden, loss of productivity) due to undertreatment or nontreatment of NVAF 45 .…”

Section: Economic Consequences Of Undertreatment and Nontreatmentmentioning

confidence: 99%

The burden of undertreatment and non-treatment among patients with non-valvular atrial fibrillation and elevated stroke risk: a systematic review

Sussman¹,

Barnes

Guo

et al. 2021

Current Medical Research and Opinion

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Objective: Global treatment guidelines recommend treatment with oral anticoagulants (OACs) for patients with non-valvular atrial fibrillation (NVAF) and an elevated stroke risk. However, not all patients with NVAF and an elevated stroke risk receive guideline-recommended therapy. A literature review and synthesis of observational studies were undertaken to identify the body of evidence on untreated and undertreated NVAF and the association with clinical and economic outcomes. Methods: An extensive search (1/2010-4/2020) of MEDLINE, the Cochrane Library, conference proceedings, and health technology assessments (HTAs) was conducted. Studies must have evaluated rates of nontreatment or undertreatment in NVAF. Nontreatment was defined as absence of OACs (but with possible antiplatelet treatment), while undertreatment was defined as treatment with only antiplatelet agents. Results: Sixteen studies met our inclusion criteria. Rates of nontreatment for patients with elevated stroke risk ranged from 2.0-51.1%, while rates of undertreatment ranged from 10.0-45.1%. The clinical benefits of anticoagulation were reported in the evaluated studies with reductions in stroke and mortality outcomes observed among patients treated with anticoagulants compared to untreated or undertreated patients. Adverse events associated with all bleeding types (i.e. hemorrhagic stroke, major bleeding or gastrointestinal hemorrhaging) were found to be higher for warfarin patients compared to untreated patients in real-world practice. Healthcare resource utilization was found to be lower among patients highly-adherent to warfarin compared to untreated patients. Conclusions: Rates of nontreatment and undertreatment among NVAF patients remain high and are associated with preventable cardiovascular events and death. Strategies to increase rates of treatment may improve clinical outcomes.

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Section: Economic Consequences Of Undertreatment and Nontreatmentmentioning

confidence: 99%

The burden of undertreatment and non-treatment among patients with non-valvular atrial fibrillation and elevated stroke risk: a systematic review

Sussman¹,

Barnes

Guo

et al. 2021

Current Medical Research and Opinion

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“…The incidence and prevalence of arrhythmias increase exponentially with age ( 7 ). According to present evidence, 10 percent of the population over 80 years of age have AF ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of New Oral Anticoagulants for the Prevention of Stroke in Patients with Atrial Fibrillation in Low and Middle-Income Countries: A Systematic Review

Souresrafil

Abutorabi

Peighambari

et al. 2022

Med. J. Islam. Republ. Iran

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Background: Low- and middle-income (LMICs) countries are facing with a high incidence of cardiovascular diseases and limited resources for confronting these diseases. Atrial fibrillation(AF) is the most common cardiac arrhythmia in the world that is associated with significant morbidity and mortality. This study assessed cost-effectiveness studies of novel oral anticoagulants(NOACs) compared to Warfarin for the prevention of stroke in patients with AF in LMICs. Methods: In this systematic review study, electronic databases were searched for economic evaluation studies about NOACs cost-effectiveness conducted in LMICs between 2008 and 2019. The selection of studies for review was also based on the PICO (population, intervention, comparison, and outcomes) guidelines. In this study, the population was restricted to patients with atrial fibrillation living in LMICs. We identified three types of drugs (apixaban, rivaroxaban, dabigatran, and edoxaban) as interventions and warfarin as the comparison therapy. Quality of Health Economic Studies checklist was used to evaluate the quality of the included articles. Results: Sixteen articles were extracted, including four cost-effectiveness analyses and two cost-utility analyses. QHES scores ranged from 58 to 87.5 out of a possible 100 points, with a mean score of 77.34. The results of the study showed that from a social perspective, Edoxaban is the most cost-effective therapeutic option compared to warfarin and other NOACs, but Warfarin was much more cost-effective than Rivaroxaban and Apixaban. Furthermore, NOACs were more cost-effective than warfarin from the payer perspective, but from the health system perspective, all NOACs were dominated by warfarin. Conclusion: The present systematic review demonstrates that from a social perspective, Edoxaban is the optimal alternative to warfarin other NOACs for stroke prevention in patients with AF in (LMICs). one study was found on the economic evaluation of NOACs and warfarin in patients with AF in low-income countries, so further research on the economic evaluation of these drugs is recommended.

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“…Several systematic reviews focused on the cost of stroke (classified as cardiovascular disease) in patients with type 2 diabetes mellitus [ 12 ], hypertension [ 13 ] or atrial fibrillation [ 14 ]. Other reviews focused exclusively on post-stroke care [ 15 ] or stroke-related costs in low and middle-income countries [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

The economic burden of stroke: a systematic review of cost of illness studies

Strilciuc¹,

Grad²,

Radu³

et al. 2021

JMedLife

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Stroke is one of the leading causes of morbidity and mortality worldwide. As the number of stroke cases is rising from one year to another, policymakers require data on the amount spent on stroke to enforce better financing policies for prevention, hospital care, outpatient rehabilitation services and social services. We aimed to systematically assess the economic burden of stroke at global level. Cost of stroke studies were retrieved from five databases. We retrieved the average cost per patient, where specified, or estimated it using a top-down approach. Resulting costs were grouped in two main categories: per patient per year and per patient lifetime. We extracted information from forty-six cost of illness studies. Per patient per year costs are larger in high income countries and in studies conducted from the payer perspective. The highest average per patient per year cost by country was reported in the United States ($59,900), followed by Sweden ($52,725) and Spain ($41,950). The highest per patient lifetime costs were reported in Australia ($232,100) for all identified definitions of stroke. Existing literature regarding the economic burden of stroke is concentrated in high-income settings, with very few studies conducted in South America and Africa. Published manuscripts on this topic highlight substantial methodological heterogeneity, rendering comparisons difficult or impossible, even within the same country or among studies with similar costing perspectives.

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Systematic review of societal costs associated with stroke, bleeding and monitoring in atrial fibrillation

Cited by 5 publications

References 44 publications

The burden of undertreatment and non-treatment among patients with non-valvular atrial fibrillation and elevated stroke risk: a systematic review

The burden of undertreatment and non-treatment among patients with non-valvular atrial fibrillation and elevated stroke risk: a systematic review

Cost-effectiveness of New Oral Anticoagulants for the Prevention of Stroke in Patients with Atrial Fibrillation in Low and Middle-Income Countries: A Systematic Review

The economic burden of stroke: a systematic review of cost of illness studies

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