Atrial fibrillation: the cost of illness in Sweden

Lisa Ericson, Lennart Bergfeldt, Ingela Björholt, Lisa Ericson, Lennart Bergfeldt, Ingela Björholt

Abstract

Aim: To provide an estimate of the annual cost of atrial fibrillation (AF) in Sweden.

Methods: Prevalence-based cost analysis of AF in Sweden for 2007. Direct medical (hospitalizations, hospital outpatient care, primary health care, non-pharmacological interventions, pharmaceuticals, and anticoagulation monitoring) and non-medical (transportation associated with health care visits) costs of AF, direct costs of AF complications (stroke and heart failure), and indirect costs (production loss), were included. Data were based on Swedish registries, reports and databases, published literature, and an expert panel.

Results: There were 100,557 individuals with AF as primary or secondary diagnosis that were either hospitalized or treated in hospital outpatient care in 2007. The total cost of AF was estimated at <euro>708 million. The major cost driver was the direct cost of complications (54%), followed by hospitalization due to AF including AF as secondary diagnosis (18%), and production loss (12%).

Conclusion: This is a comprehensive, nation-based cost analysis of AF where relevant data were derived from national registries covering the entire Swedish population. The results showed that the annual cost of AF was high in comparison with other diseases, but likely to be underestimated as a conservative approach was applied in the analysis.

Figures

Fig. 1
Fig. 1
Proportion of women and men in patients with atrial fibrillation (n = 100,557), by age subgroups
Fig. 2
Fig. 2
Proportion of women and men in patients with atrial fibrillation, as a percentage of the Swedish population for each age interval

References

    1. Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S, Smith SC, Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Hunt SA, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Zamorano JL. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 guidelines for the management of patients with atrial fibrillation) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace. 2006;8:651–745. doi: 10.1093/europace/eul097.
    1. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285:2370–2375. doi: 10.1001/jama.285.18.2370.
    1. Butler RN. Population aging and health. BMJ. 1997;315:1082–1084.
    1. MacIntyre K, Capewell S, Stewart S, Chalmers JW, Boyd J, Finlayson A, Redpath A, Pell JP, McMurray JJ. Evidence of improving prognosis in heart failure: trends in case fatality in 66 547 patients hospitalized between 1986 and 1995. Circulation. 2000;102:1126–1131.
    1. Peltonen M, Stegmayr B, Asplund K. Time trends in long-term survival after stroke: the Northern Sweden Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, 1985–1994. Stroke. 1998;29:1358–1365. doi: 10.1161/01.STR.29.7.1358.
    1. Rosamond WD, Chambless LE, Folsom AR, Cooper LS, Conwill DE, Clegg L, Wang CH, Heiss G. Trends in the incidence of myocardial infarction and in mortality due to coronary heart disease, 1987 to 1994. N. Engl. J. Med. 1998;339:861–867. doi: 10.1056/NEJM199809243391301.
    1. Schaufelberger M, Swedberg K, Köster M, Rosén M, Rosengren A. Decreasing one-year mortality and hospitalization rates for heart failure in Sweden; Data from the Swedish Hospital Discharge Registry 1988 to 2000. Eur. Heart J. 2004;25:300–307. doi: 10.1016/j.ehj.2003.12.012.
    1. Stegmayr B, Asplund K. Stroke in Northern Sweden. Scand. J. Public Health Suppl. 2003;61:60–69. doi: 10.1080/14034950310001379.
    1. Le Heuzey JY, Paziaud O, Piot O, Said MA, Copie X, Lavergne T, Guize L. Cost of care distribution in atrial fibrillation patients: the COCAF study. Am. Heart J. 2004;147:121–126. doi: 10.1016/S0002-8703(03)00524-6.
    1. McBride D, Mattenklotz AM, Willich SN, Brüggenjürgen B. The costs of care in atrial fibrillation and the effect of treatment modalities in Germany. Value Health. 2008;12:293–301. doi: 10.1111/j.1524-4733.2008.00416.x.
    1. Reynolds MR, Essebag V, Zimetbaum P, Cohen DJ. Healthcare resource utilization and costs associated with recurrent episodes of atrial fibrillation: the FRACTAL registry. J. Cardiovasc. Electrophysiol. 2007;18:628–633. doi: 10.1111/j.1540-8167.2007.00819.x.
    1. Ringborg A, Nieuwlaat R, Lindgren P, Jönsson B, Fidan D, Maggioni AP, Lopez-Sendon J, Stepinska J, Cokkinos DV, Crijns HJ. Costs of atrial fibrillation in five European countries: results from the Euro Heart Survey on atrial fibrillation. Europace. 2008;10:403–411. doi: 10.1093/europace/eun048.
    1. Stewart S, Murphy NF, Walker A, McGuire A, McMurray JJ. Cost of an emerging epidemic: an economic analysis of atrial fibrillation in the UK. Heart. 2004;90:286–292. doi: 10.1136/hrt.2002.008748.
    1. Ekman M. Economic evidence in stroke: a review. Eur. J. Health Econ. 2004;5:S74–S83. doi: 10.1007/s10198-005-0292-3.
    1. Henriksson F, Jönsson B. Diabetes: the cost of illness in Sweden. J. Intern. Med. 1998;244:461–468. doi: 10.1111/j.1365-2796.1998.00388.x.
    1. Nieuwlaat R, Capucci A, Camm AJ, Olsson SB, Andresen D, Davies DW, Cobbe S, Breithardt G, Le Heuzey JY, Prins MH, Lévy S, Crijns HJ. Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation. Eur. Heart J. 2005;26:2422–2434. doi: 10.1093/eurheartj/ehi505.
    1. Auricula. The atrial fibrillation and anticoagulation registry. Annual report 2007 (In Swedish) (2007). Available at: . Accessed March 2009
    1. Davidson, T., Levin, L.Å.: Kostnaden för förmaksflimmer i Östergötland. CMT Report 2006:5 (In Swedish) (2006). Available at: . Accessed March 2009
    1. Friberg L, Hammar N, Rosenqvist M. Stroke in paroxysmal atrial fibrillation: report from the Stockholm Cohort of Atrial Fibrillation. Eur. Heart J. 2010;31:967–975. doi: 10.1093/eurheartj/ehn599.
    1. Nilsson GH, Björholt I. Occurrence and quality of anticoagulant treatment of chronic atrial fibrillation in primary health care in Sweden: a retrospective study on electronic patient records. BMC Clin. Pharmacol. 2004;4:1. doi: 10.1186/1472-6904-4-1.
    1. FASS, Pharmaceutical Specialties in Sweden (2009). Available at: . Accessed March 2009
    1. Björholt I, Andersson S, Nilsson GH, Krakau I. The cost of monitoring warfarin in patients with chronic atrial fibrillation in primary care in Sweden. BMC Fam. Pract. 2007;8:6. doi: 10.1186/1471-2296-8-6.
    1. Björholt I, Andersson FL, Kahan T, Östergren J. The cost-effectiveness of ramipril in the treatment of patients at high risk of cardiovascular events: a Swedish sub-study to the HOPE study. J. Intern. Med. 2002;251:508–517. doi: 10.1046/j.1365-2796.2002.00990.x.
    1. Atrial fibrillation Investigators Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch. Intern. Med. 1994;154:1449–1457. doi: 10.1001/archinte.154.13.1449.
    1. The Swedish National Board of Health and Welfare. [National guidelines]. Nationella riktlinjer för strokesjukvård. Beslutsstöd för prioriteringar (In Swedish) (2009). Available at: . Accessed March 2009
    1. Ghatnekar O, Persson U, Glader EL, Terent A. Cost of stroke in Sweden: an incidence estimate. Int. J. Technol. Assess. Health Care. 2004;20:375–380. doi: 10.1017/S0266462304001217.
    1. Ghatnekar O, Glader EL. The effect of atrial fibrillation on stroke-related inpatient costs in Sweden: a 3-year analysis of registry incidence data from 2001. Value Health. 2008;11:862–868. doi: 10.1111/j.1524-4733.2008.00359.x.
    1. Agvall B, Dahlström U. Patients in primary health care diagnosed and treated as heart failure, with special reference to gender differences. Scand. J. Prim. Health Care. 2001;19:14–19. doi: 10.1080/028134301300034549.
    1. Mejhert M, Persson H, Edner M, Kahan T. Epidemiology of heart failure in Sweden—a national survey. Eur. J. Heart Failure. 2001;3:97–103. doi: 10.1016/S1388-9842(00)00115-X.
    1. Medical Products Agency Diagnostik och behandling av kronisk hjärtsvikt—behandlingsrekommendationer (In Swedish) Information från Läkemedelsverket. 2006;17:7–17.
    1. Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna W, Seward JB, Iwasaka T, Tsang TS. Incidence and mortality risk of congestive heart failure in atrial fibrillation patients: a community-based study over two decades. Eur. Heart J. 2006;27:936–941. doi: 10.1093/eurheartj/ehi694.
    1. Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, D’Agostino RB, Murabito JM, Kannel WB, Benjamin EJ. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003;107:2920–2925. doi: 10.1161/01.CIR.0000072767.89944.6E.
    1. Agvall B, Borgquist L, Foldevi M, Dahlström U. Cost of heart failure in Swedish primary healthcare. Scand. J. Prim. Health Care. 2005;23:227–232. doi: 10.1080/02813430500197647.
    1. Rho RW, Page RL. Asymptomatic atrial fibrillation. Prog. Cardiovasc. Dis. 2005;48:79–87. doi: 10.1016/j.pcad.2005.06.005.
    1. Moeremans K, Aliot E, de Chillou C, Annemans L, Le Pen C, de Jong P. Second line pharmacological management of paroxysmal and persistent atrial fibrillation in France: a cost analysis. Value Health. 2000;3:407–416. doi: 10.1046/j.1524-4733.2000.36001.x.
    1. Sobocki P, Lekander I, Borgström F, Ström O, Runeson B. The economic burden of depression in Sweden from 1997 to 2005. Eur. Psychiatry. 2007;22:146–152. doi: 10.1016/j.eurpsy.2006.10.006.
    1. Lidgren M, Wilking N, Jönsson B. Cost of breast cancer in Sweden in 2002. Eur. J. Health Econ. 2007;8:5–15. doi: 10.1007/s10198-006-0003-8.
    1. Borgström F, Sobocki P, Ström O, Jönsson B. The societal burden of osteoporosis in Sweden. Bone. 2007;40:1602–1609. doi: 10.1016/j.bone.2007.02.027.

Source: PubMed

Подписаться