Economic Implications of NVAF Diagnosis for Medicare Beneficiaries

San Antonio—Atrial fibrillation (AF) is the most common form of cardiac arrhythmia, affecting between 2.7 million to 6 million US individuals. The prevalence of AF increases with age, affecting almost 10% of the population aged ≥80 years. In addition, non-valvular AF (NVAF) affects 85% of the AF population. Both stroke and hemorrhaging impact the treatment and economic impact of AF.

During a poster session at the AMCP meeting, study authors, Kate Fitch, RN, MEd, et al, shared results of a study assessing the incremental cost of ischemic stroke and hemorrhagic events in Medicare beneficiaries that are newly diagnosed with NVAF in the first 12 months following NVAF diagnosis. The poster was titled Impact of Stroke and Hemorrhage on First-Year Healthcare Costs after Diagnosis with Non-Valvular Atrial Fibrillation (NVAF) among Medicare Patients.

This was a retrospective analysis of patients with AF claims from 2006 through 2008 using Medicare 5% sample research identifiable file (RIF). Inclusion criteria for participation were more than 1 inpatient, emergency room (ER), or physician evaluation and management claim with a primary or secondary diagnosis of International Statistical Classification of Diseases and Related Health Problems (ICD) code 427.31; no less than 30 days between the 2 AF claims; at least 1 claim in the outpatient setting; no claims with ICD 9 code 427.31 in the 12 months prior to index; and ≥18 years of age. Study participants were then classified into 1 of 4 cohorts during the 12 month follow-up period: (1) no stroke, no hemorrhage (n=8905); (2) hemorrhage, no stroke (n=276); (3) stroke, no hemorrhage (n=261); and (4) stroke and hemorrhage (n=13). Healthcare resources were measured in terms of inpatient admissions, ER visits, and outpatient visits during the 12-month follow-up period. Mean healthcare costs were compared.

The average rate of ischemic stroke was 3.3% and the average rate of bleeding claims was 3.4% in the overall study sample. The mean total cost per member was $37,157, with almost 50% of the cost attributed to inpatient care. During the follow-up period, for the no stroke, no hemorrhage group, $35,474 was attributed to the mean healthcare costs. For the hemorrhage, no stroke group, $64,596 was attributed to the mean healthcare costs. For the stroke, no hemorrhage group, $63,781 was attributed to the mean healthcare costs. For the stroke and hemorrhage group, $72,984 was attributed to the mean healthcare costs.

When compared with patients who did not have a stroke or hemorrhage during the follow-up period, patients with either hemorrhage or stroke claims had a 74% increase in total annual healthcare costs, and patients with both hemorrhage and stroke claims had a 99% increase in total annual healthcare costs.

In conclusion, the study authors note that NVAF poses a substantial medical and economic burden in Medicare beneficiaries due to the increased risk of stroke and hemorrhage. 

This study was sponsored by Daiichi Sankyo, Inc.