Acute Hospital, Community, and Indirect Costs of Stroke Associated With Atrial Fibrillation

Authors: Niamh Hannon , Leslie Daly , Sean Murphy , Samantha Smith , Derek Hayden , Elizabeth Callaly , Gillian Horgan , Bahman Honari
Stroke: a journal of cerebral circulation , Vol. 45, 2014 , pp. 3670-3674

Full list of Authors: Niamh Hannon, Leslie Daly, Sean Murphy, Samantha Smith, Derek Hayden, Danielle Ní Chróinín, Elizabeth Callaly, Gillian Horgan, Órla Sheehan, Bahman Honari, Joseph Duggan, Lorraine Kyle, Eamon Dolan, David Williams, Miriam Wiley, Peter J Kelly.

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 ò16; 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.