Medical Costs and Productivity Losses of Atrial Fibrillation Among US Privately Insured Employees

Importance Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major factor underlying US health care costs. While its clinical burden is well documented, the full economic impact of AF—particularly among working-age adults with productivity losses—remains underexplored. Objective To estimate medical costs and productivity losses associated with AF among privately insured US employees and assess whether this burden varies by sex and rurality. Design, Setting, and Participants This cross-sectional study used 2021 Merative MarketScan Commercial Claims and Health and Productivity Management Databases. The sample included adults aged 18 to 64 years with continuous enrollment in noncapitated, employer-sponsored insurance and no pregnancy-related diagnoses. Analyses were conducted during January to July 2025. Exposures Diagnosis of AF, defined by 1 or more inpatient or emergency department claims or 2 or more outpatient claims with International Classification of Disease, Tenth Revision, Clinical Modification code I48. Main Outcomes and Measures Primary outcomes were total all-cause annual medical costs and productivity losses. Medical costs were disaggregated into emergency department, inpatient, outpatient, and prescription costs. Productivity losses included sick leave, short-term disability, and long-term disability; days were observed directly, and dollar-valued costs were estimated by applying national average wages. All outcomes were prespecified. Propensity score overlap weighting was applied to balance covariates. Results Among 1 612 398 individuals (mean [SD] age, 44.00 [11.11] years; 623 335 female [38.66%]; 1 489 709 [92.39%] living in an urban area), 10 190 (0.63%) were diagnosed with AF. AF was associated with $11 392.55 (95% CI, $10 649.70-$12 135.38) in incremental annual medical costs, primarily from outpatient care ($7058.81 [95% CI, $6563.89-$7553.72] for services and $1874.58 [95% CI, $1600.61-$2148.56] for prescriptions). Compared with those without AF, those with AF had 0.97 (95% CI, 0.02-1.93) excess sick leave days and 2.93 (95% CI, 2.14-3.72) excess short-term disability days, translating to productivity-related costs of $269.81 (95% CI, $144.65-$397.77) for sick leave and $570.51 (95% CI, $471.21-$669.81) for short-term disability. Long-term disability outcomes did not differ significantly. Females incurred higher AF-related emergency (mean difference, $422.61; 95% CI, $178.32-$666.89) and inpatient care costs (mean difference, $1588.67; 95% CI, $466.23-$2711.12) than males. Conclusions and Relevance In this cross-sectional study of privately insured employees, AF was associated with $11 393 in higher medical costs per person, with outpatient care accounting for the largest share, and $840 in higher productivity losses per person. These findings underscore the need to improve outpatient treatment and reduce AF-related workplace disruptions for working-age adults.