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Population-based study of acute- and long-term care costs after stroke in patients with AF
Ramon Luengo-Fernandez1, Gabriel S C Yiin, Alastair M Gray
1Health Economics Research Centre, Department of Public Health, Old Road Campus, University of Oxford, Oxford, UK.
Insights
Stroke costs in atrial fibrillation patients are substantial, particularly long-term care expenses. Understanding these costs is crucial for evaluating new atrial fibrillation treatments and their cost-effectiveness.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Public Health
Background:
- Atrial fibrillation (AF) treatments reduce vascular events, but cost-effectiveness data are limited.
- Assessing stroke costs in AF patients is essential for treatment evaluation.
Purpose of the Study:
- To evaluate the acute and long-term economic burden of stroke in patients with atrial fibrillation.
- To inform cost-effectiveness analyses of new AF therapies.
Main Methods:
- Utilized data from the population-based Oxford Vascular Study.
- Analyzed health-care costs one year pre-stroke and five years post-stroke.
- Included acute (3-month) and post-acute (annual) costs, plus institutionalization expenses.
Main Results:
- 191 strokes occurred in 153 AF patients.
- Mean acute phase costs: £10,413.
- Annual post-acute costs were not significantly different from baseline (£2400 vs. £3356).
- Long-term institutionalization costs averaged £6880 annually for survivors.
Conclusions:
- Post-acute health-care costs for stroke in AF patients did not significantly exceed pre-stroke costs.
- Substantial long-term costs associated with nursing and residential care were observed.
- Further economic evaluations are needed to assess treatment cost-effectiveness.
Background:
New treatments for atrial fibrillation patients have been shown to be effective at reducing subsequent vascular event recurrence. However, there are few data on stroke costs in atrial fibrillation patients to allow the cost-effectiveness of these treatments to be assessed.
Aims:
Using data from a population-based study, we assessed the acute and long-term costs of stroke in atrial fibrillation patients.
Methods:
Health-care costs one-year before and five-years after stroke were obtained from a large population-based study (Oxford Vascular study). Costs were assessed for the three-months poststroke (acute period) and annually thereafter (postacute period). Annual postacute costs were compared with annual baseline costs. Based on patients' living arrangements, costs of institutionalization after the event were included.
Results:
A total of 191 strokes occurred in 153 patients with known prior atrial fibrillation. Mean health-care costs after stroke were £10 413 (standard deviation 15 105) in the acute phase, with annual postacute health-care costs nonsignificantly smaller than those incurred before the event (£2400 vs. £3356, respectively; P = 0·198). However, for the 136 strokes surviving past the 90-day acute period, costs were nonsignificantly higher than those incurred in the year before the event (£3370 vs. £2566, respectively; P = 0·333). After stroke, 25 (13%) patients were newly admitted into long-term warden, nursing, or residential care, resulting in annual costs of £6880 (standard deviation 15 600) averaged across the 136 stroke cases surviving past the acute period.
Conclusions:
Although annual post acute phase hospital and primary health-care costs in stroke patients with prior atrial fibrillation were not significantly different to those incurred before the stroke, long-term nursing/residential care costs were substantial.