A pharmacoeconomic perspective on stroke prevention in atrial fibrillation

Atrial fibrillation (AF) is predictive of higher costs for stroke care, in part due to the influence of AF on stroke severity. Costs associated with severe strokes, which are more likely in patients with AF, are about twice those of mild strokes. Thus, adequately weighing the costs associated with stroke care is important when making prevention and treatment recommendations for patients diagnosed with AF. Costs associated with AF are estimated at $6.65 billion annually, which breaks down to 44% for hospitalizations, 29% for the incremental inpatient costs of AF as a comorbid diagnosis, 23% for outpatient treatment of AF, and 4% for medications. A diagnosis of AF should be followed by careful consideration of the treatment plan. Clinicians who tend to underuse warfarin should consider whether the patient has valid contraindications to warfarin or if the risk of stroke would be unacceptably high using the alternative--low-dose aspirin. Optimal use of anticoagulation in patients with AF is projected to result in substantial savings in direct costs. Optimization of anticoagulation therapy in only half of the suboptimally anticoagulated patients with AF would save approximately $1.3 billion annually. New and emerging oral alternatives to warfarin promise to combine the advantages of oral dosing and effective anticoagulation with improvements in safety, leading to reduced monitoring and dose adjustment. As these agents become available, treatment decisions will likely incorporate economic considerations, such as the costs of medication, patient monitoring, and treatment of bleeding events.