The cost of illness of atrial fibrillation: a systematic review of the recent literature

Wolowacz, Sorrel; Samuel, Michelle; Brennan, Victoria K; Jasso-Mosqueda, J. G.; Gelder, van Isabelle

doi:10.1093/europace/eur194

Cited by 209 publications

(142 citation statements)

References 49 publications

(71 reference statements)

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“…Consistent with previous published cost of illness of atrial fibrillation 13 , hospitalization cost for the treatment of stroke was the major driver of overall cost in this review. Our study found that the median LOS in hospitals for stroke patients with AF was estimated to be 15.5 days.…”

Section: Discussionsupporting

confidence: 86%

“…Due to the limited information provided in the reviewed studies, it is difficult to further explore the relationship between medical costs and time horizon. Lastly, compared with other costs of illness systematic reviews for AF 13 and other diseases 46,47 …”

Section: Discussionmentioning

confidence: 99%

“…The cost of AF has been reported in a published review of economic evaluations 13 . However, the impact of ischemic stroke on AF related healthcare costs had not been researched at the time the study was conducted.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Ischemic Stroke on Atrial Fibrillation-Related Healthcare Cost: A Systematic Review

Au-Doung

Chan

2016

Value in Health

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Aim: To summarize healthcare costs incurred by patients with atrial fibrillation (AF) who developed ischemic stroke, explore factors associated with increased cost and highlight the importance of anticoagulation therapy for stroke prophylaxis. Methods:A systematic literature search of PubMed, EMBASE, Web of Science and the health economic evaluation database was conducted up to December 2015. Studies focused on the cost and/or resource utilization of ischemic stroke in patients with AF were included. Reported costs were converted to international dollars (I$) and adjusted to 2015 values. Alongside the narrative review of included studies, Spearman's correlation, independent-samples t-test and one-way ANOVA were used to explore factors associated with cost differences between studies.Results: Sixteen studies published from nine countries were identified. Based on currency conversion rates in 2015, ischemic stroke related healthcare costs were estimated to be I$41,420, I$12,895 and I$8,184 for high-income, upper middle-income and lower middle-income economies respectively. Local GDP per capita accounted for approximately 50% of the healthcare cost variation among countries. Major component of overall cost was from hospitalization. Ischemic stroke incurring in patients with AF ≥75 years were 2.3 times that of their younger peers (p=0.049). Conclusions:The economic burden from ischemic stroke in patients with AF is considerable with positive association to country income. Clinicians and stakeholders should be aware of the importance of anticoagulation therapies in stroke prophylaxis, the occurrence of stroke and the downstream economic burden on an increasingly aging population.Keywords: stroke prophylaxis; atrial fibrillation; anticoagulation therapy; healthcare cost 3 Condensed abstractThis systematic review estimated stroke-related healthcare cost across nine countries, with a positive correlation to country income. The cost for elderly patients' ≥75 years was doubled against their younger peers. Adequate anticoagulation therapy for stroke prophylaxis and the downstream clinical and economic benefits in increasingly aging population are highlighted.4

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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The Impact of Ischemic Stroke on Atrial Fibrillation-Related Healthcare Cost: A Systematic Review

Au-Doung

Chan

2016

Value in Health

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“…Общие затраты на терапию одного пациента с ФП в год достаточно высоки и составляют в США $2000-14200, а в странах Европы -€450-3000, что сопо-ставимо с затратами на терапию сахарного диабета (€5262 в Германии) и стабильной стенокардии ($4949 в США) [13]. Прямые затраты на ФП в Великобрита-нии в 2000 г. достигли 0,9-2,4% от бюджета системы здравоохранения [13].…”

Section: результаты и обсуждениеunclassified

Analysis of the Influence of Thromboembolic Complications Prevention With Oral Anticoagulants on Budget in Patients With Non-Valvular Atrial Fibrillation

Рудакова¹

2015

Racionalʹnaâ farmakoterapiâ v kardiologii

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Санкт-Петербургская химико-фармацевтическая академия 197376 Санкт-Петербург, ул. профессора Попова, 14Фибрилляция предсердий (ФП) является фактором риска развития тромбоэмболических осложнений, требующих назначения антагонистов витамина К (варфари-на) или новых пероральных антикоагулянтов (апиксабана, дабигатрана и ривароксабана). Цель. Анализ влияния на бюджет применения апиксабана в качестве альтернативы варфарину, дабигатрану и ривароксабану у пациентов с неклапанной ФП в Рос-сийской Федерации (РФ). Материал и методы. Анализ осуществляли с позиции бюджета здравоохранения в рамках временного горизонта, составившего 5 лет, с использованием фармакоэ-кономической модели, разработанной Pharmerit International (Роттердам, Голландия) и адаптированной для условий системы здравоохранения РФ. Частота сердеч-но -сосудистых осложнений в модели соответствовала результатам сравнительных клинических исследований ARISTOTLE, AVERROES, RE-LY, ROCKET-AF. Проведенный анализ предполагал, что в начале исследования 100% пациентов с ФП переводятся с терапии варфарином, дабигатраном или ривароксабаном на апик-сабан. Анализ проводили с учетом допущения, что пациенты полностью привержены к терапии на протяжении горизонта исследования, т.е. отказ от терапии не учи-тывался. В рамках исследования учитывали возможность развития эпизодов ишемических и геморрагических инсультов, тяжесть которых соответствовала ранее опуб-ликованным данным, характерным для российской популяции пациентов. Представленное исследование проводилось с учетом двух сценариев, в одном из которых стоимость терапии антикоагулянтами определялась на основании средневзвешенных цен государственных закупок за период с 01.04.14 по 01.04.15, в то время как альтернативный сценарий, целью которого было продемонстрировать возможную эко-номию бюджета системы здравоохранения на фоне включения лекарственного средства апиксабан в перечень жизненно необходимых и важнейших лекарственных препаратов (ЖНВЛП), учитывал, что стоимость дабигатрана и ривароксабана соответствовала зарегистрированной предельной отпускной цене с учетом 10% НДС и 10% оптовой надбавки, а стоимость апиксабана -предполагаемой предельной отпускной цене, которую компания-производитель планирует зарегистрировать в слу-чае включения препарата в перечень ЖНВЛП, с учетом 10% НДС и 10% оптовой надбавки. Затраты на терапию осложнений соответствовали тарифу ОМС по г. Санкт-Петербургу на 2015 г. Результаты. Согласно эпидемиологическим данным, расчетная численность пациентов с неклапанной ФП, нуждающихся в терапии антикоагулянтами, в масштабах РФ достигает 1196,6 тыс. чел. В соответствии с результатами проведенного исследования, терапия с применением апиксабана существенно снижает частоту всех сер-дечно-сосудистых осложнений по сравнению с варфарином и ривароксабаном. Результаты анализа влияния на бюджет, полученные с учетом цен аукционов за период с 01.04.14 по 01.04.15, демонстрируют снижение нагрузки на бюджет при включе-нии апиксабана в схемы лечения ФП. Так, возможная экономия ресурсов системы здравоохранения достигает 10...

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“…42 Most of the costs associated with the complications of AF are due to hospitalization; a systematic literature review estimated that hospitalization represented 50%-70% of the annual direct costs of AF. 43 …”

Section: 31mentioning

confidence: 99%

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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The cost of illness of atrial fibrillation: a systematic review of the recent literature

Cited by 209 publications

References 49 publications

The Impact of Ischemic Stroke on Atrial Fibrillation-Related Healthcare Cost: A Systematic Review

The Impact of Ischemic Stroke on Atrial Fibrillation-Related Healthcare Cost: A Systematic Review

Analysis of the Influence of Thromboembolic Complications Prevention With Oral Anticoagulants on Budget in Patients With Non-Valvular Atrial Fibrillation

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

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