October 7, 2009Current Medical Research and Opinion

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

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic nonvalvular atrial fibrillation (n=3891). Intervention: Onset of chronic nonvalvular atrial fibrillation vs. Pre-AF onset period. Primary outcome: Total direct healthcare costs per member per month (pmpm) (200% increase).

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Key result

Onset of chronic nonvalvular atrial fibrillation was associated with a 200% increase in total direct healthcare costs from $412 pre-AF to $1235 per member per month post-AF.

Why the study?

Does warfarin utilization reduce total direct healthcare costs in patients with incident chronic nonvalvular atrial fibrillation?

Population

3,891 continuously benefit-eligible patients with incident chronic nonvalvular atrial fibrillation ≥45 years…

Comparison

Warfarin utilization vs No warfarin exposure and pre-AF onset period

Design

Cohort

Follow-up

at least 6 months

Authors

SBStephen J. BoccuzziAetna (United States)JMJohn MartinPremier Research Group JSJudith StephensonLondon Women's Clinic

Discussion

Member takes

Implication

Incident AF triples direct costs; leaves open whether anticoagulation offsets this in observational cohorts.

Study Design

Type

Cohort (n=3,891)

Multicenter

Yes

Structured PICO

Does warfarin utilization reduce total direct healthcare costs in patients with incident chronic nonvalvular atrial fibrillation?

Population

3,891 patients aged ≥45 years with incident chronic nonvalvular atrial fibrillation, without prior valvular disease or warfarin use, followed for at least 6 months.

Exposure

Warfarin utilization (defined as having filled at least one pharmacy claim)

Comparator

No warfarin exposure and pre-AF onset period

Outcome

Total direct healthcare costs (per member per month [pmpm]) pre- and post-AF index claim

Main Result

Effect estimate: 200% increase

Absolute Event Rate: 1235% vs 412%

Incident chronic nonvalvular atrial fibrillation significantly increases direct healthcare costs, while warfarin utilization is associated with a reduction in these costs.

Limitations

Descriptive retrospective study design without a comparison group
No adjustment for baseline disease severity and drug exposure
Reliance upon administrative claims data
Use of a standardized reference costing methodology
descriptive retrospective study design without a comparison group
no adjustment for baseline disease severity and drug exposure
reliance upon administrative claims data
use of a standardized reference costing methodology

Cite This Study

Boccuzzi et al. (2009) conducted a cohort in Chronic nonvalvular atrial fibrillation (n=3,891). Onset of chronic nonvalvular atrial fibrillation vs. Pre-AF onset period was evaluated on Total direct healthcare costs per member per month (pmpm) (200% increase). Onset of chronic nonvalvular atrial fibrillation was associated with a 200% increase in total direct healthcare costs from $412 pre-AF to $1235 per member per month post-AF.

synapsesocial.com/papers/6aa00595dfc81ffeb871e8c6 https://doi.org/10.1185/03007990903196422

Topics

Atrial fibrillation Persistent AF management Anticoagulation in AF

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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

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

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

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider