Abstract T P301: Annual Ischemic and Hemorrhagic Stroke Costs in an Atrial Fibrillation Population from a Health Plan Perspective
Background: Limited data evaluating the economic burden of ischemic stroke (IS), relative to that of hemorrhagic stroke (HS) from a population management perspective exist. This study estimates the 1-year stroke-related cost to manage IS and HS events in an adult population with atrial fibrillation (AF).
Methods: An incidence-based model was developed using published AF prevalence rates and stroke incidence/mortality rates observed in the MarketScan databases (2005-2011). Medical and pharmacy claims data for adult patients who had ≥1 inpatient or ≥2 outpatient claims for AF and ≥1 primary inpatient claim for stroke were analyzed. Adjusted mean costs for IS and HS index event hospitalizations and follow-up care during the 1 year following index stroke event were estimated using generalized linear models controlling for demographics, stroke type, comorbidities, and oral anticoagulant use.
Results: In a typical health plan with 1 million enrollees, we estimated that 9,500 patients would have AF. Annual stroke incidence rates among AF patients varied by age and ranged from 0.23-3.57 (IS) and 0.06-0.49 (HS) per 100 person-years, resulting in approximately 176 and 33 new cases of IS and HS in 1 year respectively. Mortality rates during IS and HS hospitalizations were 5.6% and 23.2%, respectively. Adjusted mean healthcare cost for patients who died during hospitalization was higher for IS than HS ($29,810 [95% CI $27,784-$31,987] vs. $23,492 [$21,779-$25,339], P<0.0001), while adjusted mean 1-year cost associated with IS was lower than HS among those who survived their index admission ($25,635 [95% CI $25,104-$26,173] vs. $48,850 [$46,351-$51,483], P<0.0001). Total annual stroke-related healthcare costs for the health plan were $5,991,423, with 76% of costs attributable to IS due to its higher incidence and lower mortality rate.
Conclusion: Patients with a history of AF are at risk for IS and HS, with IS accounting for more annual healthcare costs to a health plan due to its higher incidence than HS. These data may be useful in assessing the risk-benefit of anticoagulation therapy for stroke prevention in AF patients from a health plan perspective.
Author Disclosures: M. Sussman: Other Research Support; Modest; Boston Health Economics received funding from DSI for study. I. Lin: Other Research Support; Modest; Boston Health Economics received funding from DSI for study. W.J. Kwong: Employment; Significant; Daiichi Sankyo. M. Munsell: Other Research Support; Modest; Boston Health Economics received funding from DSI for study. M. Friedman: Other Research Support; Modest; Boston Health Economics received funding from DSI for study. M. Selim: Other Research Support; Modest; Received funding from DSI. J. Menzin: Other Research Support; Modest; Boston Health Economics received funding from DSI for study.
- © 2014 by American Heart Association, Inc.