Societal Costs of First-Incident Ischemic Stroke in Patients with Atrial Fibrillation-A Danish Nationwide Registry Study

Abstract

Background: Oral anticoagulation therapy reduces the risk of ischemic stroke in patients with atrial fibrillation (AF). However, more data on the costs of stroke in patients with AF are needed to assess how this therapy affects societal costs.

Objectives: The aim of the study was to estimate the average 3-year societal costs of first-incident ischemic stroke in Danish patients with AF, including costs of health care, social care services, and productivity loss.

Methods: The study was designed as an incidence-based cost-of-illness study covering the entire Danish population. All patients with a hospital diagnosis of AF were identified, and propensity score-matched analyses were used to estimate costs attributable to first-incident stroke among patients with AF in the period 2002 to 2012. All data were obtained from nationwide registries.

Results: A total of 21,673 patients with AF were identified with a first-incident stroke. The average 3-year costs attributable to stroke were US $30,925 per patient (present value) corresponding to US $19,989 in the incidence year and US $7,683 and US $5,176 1 and 2 years after the stroke, respectively. Health care accounted for 66% of the 3-year costs, with hospitalizations in the incidence year as the main cost driver. After the incidence year, costs of social care services exceeded health care costs. Sensitivity analyses showed that the cost estimates were relatively robust.

Conclusions: The societal costs of first-incident stroke in patients with AF are substantial. This new evidence can be valuable as an input for decision making regarding the treatment of AF and prevention of future strokes.

Keywords: atrial fibrillation; cost-of-illness; propensity score matching; stroke.