Acute Hospital, Community, and Indirect Costs of Stroke Associated With Atrial Fibrillation Population-Based Study

作者：Hannon Niamh; Daly Leslie; Murphy Sean; Smith Samantha; Hayden Derek; Chroinin Danielle Ni; Callaly Elizabeth; Horgan Gillian; Sheehan Orla; Honari Bahman; Duggan Joseph; Kyne Lorraine; Dolan Eamon; Williams David; Wiley Miriam; Kelly Peter J^*

来源：Stroke, 2014, 45(12): 3670-+.

DOI：10.1161/STROKEAHA.114.005960

• atrial fibrillation
• healthcare economics and organizations
• prevention and control
• stroke

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. %26lt;br%26gt;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). %26lt;br%26gt;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%26lt;0.001) and acute hospital costs (P%26lt;0.001), and greater nursing home (P=0.001) and general practitioner (P%26lt;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%26lt;0.001) but not in severe stroke (National Institutes of Health Stroke Scale %26gt;= 16; P=0.7). %26lt;br%26gt;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.

• 出版日期2014-12