Atrial fibrillation in the UK: predicting costs of an emerging epidemic recognizing and forecasting the cost drivers of atrial fibrillation-related costs

Abstract

Aims: Atrial fibrillation (AF) is the most common sustained heart arrhythmia and a major preventable cause of stroke, heart failure, and dementia. Atrial fibrillation already accounts for a significant amount of National Health Service (NHS) funding, and over the coming years is highly likely to impose a growing cost on NHS budgets and the wider UK healthcare system. We, therefore, need greater understanding of the main cost drivers (e.g. hospitalizations) of this increasingly prevalent arrhythmia. Such data would help with NHS resource planning over the next decades.

Methods and results: Based on prior published data, we initially calculated the cost of AF for 1995, and then again for 2000 which was calculated from a combination of contemporary and extrapolated data from that time. These data have been used as the basis for forecasting AF costs in the UK and as a share of total NHS expenditure. Atrial fibrillation direct costs were split between cost driver categories; general practitioner (GP) consultations, GP referred OPD (outpatient department) visits, prescriptions and monitoring visits, primary admissions, and post-discharge OPD visits. Forecast assumptions used: (i) NHS expenditure from 2020 onwards assumed to increase at annual rate of 3%/year; and (ii) the UK inflation rate to increase by 2% annually. Sensitivity modelling of 3%, 4%, and 6% projected annual increase in AF prevalence amongst the population was applied. The estimated direct and proportion of NHS expenditure of AF in 2020 for each of the assumed increases of 3%, 4%, and 6% would be £1435 m (0.91%), £1741 m (1.11%), and £2548 m (1.62%), respectively. For 2030, the modelling would mean that the direct costs of AF and proportion of NHS expenditure would be £2351 m (1.11%), £3141 m (1.48%), and £5562 m (2.63%), respectively. For 2040, the modelling shows that the direct costs of AF and proportion of NHS expenditure would be £3851 m (1.35%), £5668 m (1.99%), and £12 143 m (4.27%), respectively. By far the largest contributor to the total direct AF costs in 2020 was for primary admissions (nearly 60%), with a further 7% with post-discharge outpatient clinic visits. Taken together the total for these two categories in 2020 would cost the NHS between £949 and £1685 m, depending on the projected increase in annual rate of AF prevalence. The full cost of AF related hospitalizations may be underestimated, due to the other admissions associated with a secondary coding of AF, which in 2020 are forecast to cost between £2269 and £4030 m, depending on the annual population increase of AF prevalence. There will be an increasing number of patients discharged to a nursing home after a hospital admission associated with a principal AF diagnosis, with cost estimates for this in 2000 being £111 m, and predicted to rise to between £346 and £614 m by 2020.

Conclusion: Focusing on 2020, AF is predicted to directly cost the NHS a total of a minimum of £1435 m and a maximum of £2548 m (depending on AF prevalence); hence, between 0.9% and 1.6% of NHS expenditure, mostly from primary admissions. The total direct costs of AF would increase to 1.35-4.27% of NHS expenditure, over the next two decades. If hospitalizations can be avoided or reduced, we would substantially reduce the healthcare costs of AF to the NHS.

Keywords: Atrial fibrillation; Direct costs; Forecast; National Health Service (NHS).