Cost and resource utilisation in patients with atrial fibrillation with/without ischemic stroke

Abstract

Atrial fibrillation (AF) is a risk factor of ischaemic stroke and mainly affects elderly population. In the aging era, AF is a worldwide prevalent disease that increasingly number of people being suffered and developed ischaemic stroke later. The cost of managing ischaemic stroke can be reduced if patients with AF can receive better treatment to prevent ischaemic stroke. The cost of ischaemic stroke in patients with AF is explored in existing published literature, but the volume is limited and variations exist among costing components assessed. Besides, no systematic review has been conducted before, so it is very difficult to quantify the overall cost of ischaemic stroke.

The aim of this study is to investigate and summarize the cost and resource utilisation of patients with AF with ischaemic stroke and highlight the importance of ischaemic stroke prevention. A systematic review was conducted in four databases, including PUBMED, EMBASE, Web of Science and the health economic evaluation database (HEED)to review the existing literatures on the cost in patients with AF with ischaemic stroke. Costs reported in the included studies were converted into international dollars in 2015 values. One thousand five hundred and thirty-five studies were searched systematically and 16 studies were included following Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA).Result showed that the total direct medical cost in treating patients with ischaemic stroke ranged from$1,605 to $86,883 per patient in different countries. Hospitalization costs contributed greatest to total medical costs, accounting for nearly half of the total. In addition, the management of ischaemic stroke in patients with AF is costly. The total direct medical cost was 2 -2.8 folds higher than patients with AF without ischaemic stroke.

Furthermore, correlation analyses were conducted to investigate the relationship between GDP per capita, mean age of patients, total direct medical costs and length of stay (LOS)(as an indicator of resource utilisation).The results showed that patients had a higher total direct medical cost if they lived in a country with a higher GDP per capita value in both original reported year (r^2= 0.381, p= 0.014)and converted year of 2015(r2= 0.279, p= 0.043). However, a weak positive relationship was observed in the mean age of patients and total direct medical costs in both original reported year (r^2= 0.119, p= 0.187) and converted year (r^2= 0.125, p= 0.265). The mean length of stay (LOS) among patients with AF with ischaemic stroke ranged from 5.2 to 20 days. Elderly patients tended to stay longer in hospital, but this observation was not statistically significant (r^2= 0.393, p= 0.132).

This review provides an updated and comprehensive summary of ischaemic stroke related cost in patients with AF globally. As the management of ischaemic stroke is costly in patients with AF, there is a need to minimize the risk of ischaemic stroke in patients with AF in order to avoid a higher medical cost to patients and economic burden to the whole health care systems as well.