Niamh Hannon1, Leslie Daly1, Sean Murphy1, Samantha Smith1, Derek Hayden1, Danielle Ní Chróinín1, Elizabeth Callaly1, Gillian Horgan1, Orla Sheehan1, Bahman Honari1, Joseph Duggan1, Lorraine Kyne1, Eamon Dolan1, David Williams1, Miriam Wiley1, Peter J Kelly2. 1. From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.). 2. From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.). biovasc_projectteam@mater.ie.
Abstract
BACKGROUND AND PURPOSE: No economic data from population-based studies exist on acute or late hospital, community, and indirect costs of stroke associated with atrial fibrillation (AF-stroke). Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic agents. METHODS: In a population-based prospective study of incident and recurrent stroke treated in hospital and community settings, we investigated direct (healthcare related) and indirect costs for a 2-year period. Survival, disability, poststroke residence, and healthcare use were determined at 90 days, 1 year, and 2 years. Acute hospital cost was determined using a case-mix approach, and other costs using a bottom-up approach (2007 prices). RESULTS: In 568 patients ascertained in 1 year (2006), the total estimated 2-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 2-fold 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). CONCLUSIONS: In our population study, AF-stroke was associated with substantially higher total, acute hospital, nursing home, and general practitioner costs per patient. Targeted programs to identify AF and prevent AF-stroke may have significant economic benefits, in addition to health benefits.
BACKGROUND AND PURPOSE: No economic data from population-based studies exist on acute or late hospital, community, and indirect costs of stroke associated with atrial fibrillation (AF-stroke). Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic agents. METHODS: In a population-based prospective study of incident and recurrent stroke treated in hospital and community settings, we investigated direct (healthcare related) and indirect costs for a 2-year period. Survival, disability, poststroke residence, and healthcare use were determined at 90 days, 1 year, and 2 years. Acute hospital cost was determined using a case-mix approach, and other costs using a bottom-up approach (2007 prices). RESULTS: In 568 patients ascertained in 1 year (2006), the total estimated 2-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 2-fold 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). CONCLUSIONS: In our population study, AF-stroke was associated with substantially higher total, acute hospital, nursing home, and general practitioner costs per patient. Targeted programs to identify AF and prevent AF-stroke may have significant economic benefits, in addition to health benefits.
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