Major Bleeding in Patients with Nonvalvular Atrial Fibrillation

San Francisco—A retrospective analysis of healthcare claims for commercially insured and Medicare Advantage enrollees found that patients with nonvalvular atrial fibrillation who had major bleeding had substantially higher healthcare costs and more days in the hospital compared with those who had less severe bleeding.

Results were presented at the ACC meeting during a poster session. The poster was titled Costs of Patients with Nonvalvular Atrial Fibrillation Who Have Bleeding Events in a Large Managed Care Population.

Approximately 5 million adults in the United States have atrial fibrillation, a common cardiac rhythm disorder that is associated with a risk of bleeding, which can lead to higher costs, according to the authors.

This study examined the Optum Research Database , which contains health plan member data including enrollment information and inpatient, outpatient, and pharmacy claims. The authors obtained dates of death using the Social Security Death Master File.

Patients were included if they were ≥18 years of age and had ≥2 inpatient, emergency department, or ambulatory visits with a primary or secondary atrial fibrillation diagnosis on dates separated by at least 30 days between January 1, 2005, and June 30, 2009. They had to be continuously enrolled in the health plan for at least 1 year, and they could not have evidence of cardiac valvular disease. They were followed until they died, stopped enrollment in the plan, or June 30, 2010, whichever came first.

The analysis included 48,260 patients. The mean age was 67.3 years, 71.2% of patients had commercial insurance, 62.2% were male, and 62.9% had hypertension. The mean length of follow-up was 802 days.

The authors found that 16,409 patients had a bleeding event. The mean cost for major bleeding events (n=6684) was $16,830, while the mean cost for serious nonmajor bleeding events (n=2017) was $1822, and the mean cost for minor bleeding events (n=7708) was $611. The mean duration for the events was 8 days: 15 days for major bleeding, 3 days for serious nonmajor bleeding, and 3 days for minor bleeding.

The mean daily cost for patients without bleeding was $33.67 compared with $48.28 for those who experienced bleeding. In the major bleeding group, the mean daily cost was $63.38 compared with $47.21 for those who had serious nonmajor bleeding and $37.96 for those with minor bleeding.

The mean duration of the postbleeding period was 523 days for patients with major bleeding, 583 days for patients with serious nonmajor bleeding, and 646 days for patients with minor bleeding.

The authors noted a few limitations, including that the study relied on diagnostic codes from medical claims, which could have contained coding errors. They also noted that the results might be limited to patients with commercial or Medicare Advantage coverage and not to those with other types of coverage or the uninsured population. In addition, because the study was a descriptive, unadjusted cost analysis, patient factors other than bleeding events could have contributed to the high costs.

This study was supported by Bristol-Myers Squibb and Pfizer Inc.