Direct and indirect costs of stroke associated with AF

In a population-based prospective study of incident and recurrent stroke treated in hospital and community settings, the authors investigated direct and indirect costs for a two-year period. Survival, disability, post-stroke residence, and healthcare use were determined at 90 days, one year, and two years. Acute hospital cost was determined using a case-mix approach, and other costs using a bottom-up approach (2007 prices).

In 568 patients ascertained in one year (2006), the total estimated two-year cost was $33.84 million. In the overall sample, AF-stroke accounted for 31% (177) of patients, but a higher proportion of costs (40.5% of total and 45% of nursing home costs). On a per-patient basis compared with non–AF-stroke, AF-stroke was associated with higher total (P<0.001) and acute hospital costs (P<0.001), and greater nursing home (P=0.001) and general practitioner (P<0.001) costs among 90-day survivors.

After stratification by stroke severity in survivors, AF was associated with a twofold increase in costs in patients with mild-moderate (National Institutes of Health Stroke Scale, 0–15) stroke (P<0.001) but not in severe stroke (National Institutes of Health Stroke Scale ≥16; P=0.7).

Targeted programmes to identify AF and prevent AF-stroke may have significant economic benefits, in addition to health benefits, say the authors.

References

1. Hannon N, Daly L, Murphy S, et al. Acute hospital, community, and indirect costs of stroke associated with atrial fibrillation population-based study. Stroke 2014;45:3670–4. http://dx.doi.org/10.1161/STROKEAHA.114.005960