Long-Term Costs of Ischemic Stroke and Major Bleeding Events among Medicare Patients with Nonvalvular Atrial Fibrillation

Abstract

Purpose. Acute healthcare utilization of stroke and bleeding has been previously examined among patients with nonvalvular atrial fibrillation (NVAF). The long-term cost of such outcomes over several years is not well understood. Methods. Using 1999-2009 Medicare medical and enrollment data, we identified incident NVAF patients without history of stroke or bleeding. Patients were followed from the first occurrence of ischemic stroke, major bleeding, or intracranial hemorrhage (ICH) resulting in hospitalization. Those with events were matched with 1-5 NVAF patients without events. Total incremental costs of events were calculated as the difference between costs for patients with events and matched controls for up to 3 years. Results. Among the 25,465 patients who experienced events, 94.5% were successfully matched. In the first year after event, average incremental costs were $32,900 for ischemic stroke, $23,414 for major bleeding, and $47,640 for ICH. At 3 years after these events, costs remained elevated by $3,156-$5,400 per annum. Conclusion. While the costs of stroke and bleeding among patients with NVAF are most dramatic in the first year, utilization remained elevated at 3 years. Cost consequences extend beyond the initial year after these events and should be accounted for when assessing the cost-effectiveness of treatment regimens for stroke prevention.

Figure 1

Total quarterly cost for Medicare patients with NVAF with and without ischemic stroke. Note: P < 0.0001 for difference in costs between patients with events and matched controls at all-time points using t-test assuming unequal variances and α = 0.05 level.

Figure 2

Total quarterly cost for Medicare patients with NVAF with and without ICH. Note: P < 0.01 for difference in costs between patients with events and matched controls at all-time points using t-test assuming unequal variances and α = 0.05 level.

Figure 3

Total Quarterly Cost for Medicare Patients with NVAF with and without Other Major Bleeds. Note: P < 0.0001 for difference in costs between patients with events and matched controls at all time points using t-test assuming unequal variances and α = 0.05 level.