What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial Fibrillation (n=17580). Intervention: Atrial fibrillation vs. Population-based controls without known atrial fibrillation. Primary outcome: AF-related direct healthcare costs per year (MD CHF 5588).

September 1, 2023BMJ Open4 citationsOpen Access

Estimating the cost impact of atrial fibrillation using a prospective cohort study and population-based controls

HAHelena Aebersold FFFabienne Foster‐Witassek MSMiquel Serra‐Burriel

Key Result

Atrial fibrillation was associated with CHF 5,600 (EUR 5,091) in additional direct healthcare costs per year, resulting in medical costs that were 50% higher than those of population-based controls.

Study Design

Type

Cohort (n=17,580)

Multicenter

Yes

Structured PICO

Does the presence of atrial fibrillation increase direct healthcare costs compared to matched controls without AF?

Population

17,580 individuals, including 1,024 with prevalent atrial fibrillation and 16,556 matched population-based controls, followed for up to 5 years to estimate direct healthcare costs.

Exposure

Presence of atrial fibrillation (disease exposure)

Comparator

Matched population-based controls without known atrial fibrillation

Outcome

Direct healthcare costs from the Swiss statutory health insurance perspective over 5 years of follow-up

Atrial fibrillation is associated with a 50% increase in direct medical costs compared to matched controls, accounting for approximately 1% of total Swiss healthcare expenditure.

Main Result

Mean Difference: 5588

Absolute Event Rate: 16688% vs 11100%

Limitations

The cohort of AF patients may not be fully representative of all AF patients due to clinical center enrollment.
A limited degree of residual presence of AF in the control population cannot be ruled out.
Cost calculations were based on claims data, which may not capture all incurred costs.
Controls were provided by a single health insurance company.
Indirect costs such as lost productivity were not considered.

Abstract

AIMS: Atrial fibrillation (AF) costs are expected to be substantial, but cost comparisons with the general population are scarce. Using data from the prospective Swiss-AF cohort study and population-based controls, we estimated the impact of AF on direct healthcare costs from the Swiss statutory health insurance perspective. METHODS: Swiss-AF patients, enrolled from 2014 to 2017, had documented, prevalent AF. We analysed 5 years of follow-up, where clinical data, and health insurance claims in 42% of the patients were collected on a yearly basis. Controls from a health insurance claims database were matched for demographics and region. The cost impact of AF was estimated using five different methods: (1) ordinary least square regression (OLS), (2) OLS-based two-part modelling, (3) generalised linear model-based two-part modelling, (4) 1:1 nearest neighbour propensity score matching and (5) a cost adjudication algorithm using Swiss-AF data non-comparatively and considering clinical data. Cost of illness at the Swiss national level was modelled using obtained cost estimates, prevalence from the Global Burden of Disease Project, and Swiss population data. RESULTS: The 1024 Swiss-AF patients with available claims data were compared with 16 556 controls without known AF. AF patients accrued CHF5600 (EUR5091) of AF-related direct healthcare costs per year, in addition to non-AF-related healthcare costs of CHF11100 (EUR10 091) per year accrued by AF patients and controls. All five methods yielded comparable results. AF-related costs at the national level were estimated to amount to 1% of Swiss healthcare expenditure. CONCLUSIONS: We robustly found direct medical costs of AF patients were 50% higher than those of population-based controls. Such information on the incremental cost burden of AF may support healthcare capacity planning.

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