Patient clusters and cost trajectories in the Swiss Atrial Fibrillation cohort

Helena Aebersold¹, Miquel Serra-Burriel², Fabienne Foster-Wittassek², Giorgio Moschovitis³, Stefanie Aeschbacher^{4

5}, Angelo Auricchio⁶, Jürg Hans Beer^{7

8}, Eva Blozik⁹, Leo H Bonati^{10

11}, David Conen¹², Stefan Felder¹³, Carola A Huber¹⁴, Michael Kuehne^{4

5}, Andreas Mueller¹⁵, Jolanda Oberle^{16

17}, Rebecca E Paladini^{4

5}, Tobias Reichlin¹⁸, Nicolas Rodondi^{16

17}, Anne Springer^{4

5}, Annina Stauber¹⁵, Christian Sticherling^{4

5}, Thomas D Szucs¹⁹, Stefan Osswald^{4

5}, Matthias Schwenkglenks^{2

19}

Affiliations

¹ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland helena.aebersold@uzh.ch.
² Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
³ Division of Cardiology, Ente Ospedaliero Cantonale (EOC), Opsedale Regionale di Lugano, Lugano, Switzerland.
⁴ Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland.
⁵ Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
⁶ Department of Cardiology, Instituto Cardiocentro Ticino, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.
⁷ Department of Medicine, Cantonal Hospital of Baden, Baden, Switzerland.
⁸ Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.
⁹ Institute of Primary Care, University of Zurich, Zurich, Switzerland.
¹⁰ Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.
¹¹ Department of Neurology, University Hospital Basel, Basel, Switzerland.
¹² Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
¹³ Faculty of Business and Economics, University of Basel, Basel, Switzerland.
¹⁴ Department of Health Sciences, Helsana Group, Zurich, Switzerland.
¹⁵ Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland.
¹⁶ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
¹⁷ Department of General Internal Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
¹⁸ Department of Cardiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
¹⁹ Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.

PMID: 36332981
DOI: 10.1136/heartjnl-2022-321520

Free article

Patient clusters and cost trajectories in the Swiss Atrial Fibrillation cohort

Helena Aebersold et al. Heart. 2023.

Free article

. 2023 Apr 25;109(10):763-770.

doi: 10.1136/heartjnl-2022-321520.

Authors

Affiliations

¹ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland helena.aebersold@uzh.ch.
² Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
³ Division of Cardiology, Ente Ospedaliero Cantonale (EOC), Opsedale Regionale di Lugano, Lugano, Switzerland.
⁴ Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland.
⁵ Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
⁶ Department of Cardiology, Instituto Cardiocentro Ticino, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.
⁷ Department of Medicine, Cantonal Hospital of Baden, Baden, Switzerland.
⁸ Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.
⁹ Institute of Primary Care, University of Zurich, Zurich, Switzerland.
¹⁰ Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.
¹¹ Department of Neurology, University Hospital Basel, Basel, Switzerland.
¹² Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
¹³ Faculty of Business and Economics, University of Basel, Basel, Switzerland.
¹⁴ Department of Health Sciences, Helsana Group, Zurich, Switzerland.
¹⁵ Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland.
¹⁶ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
¹⁷ Department of General Internal Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
¹⁸ Department of Cardiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
¹⁹ Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.

PMID: 36332981
DOI: 10.1136/heartjnl-2022-321520

Abstract

Objective: Evidence on long-term costs of atrial fibrillation (AF) and associated factors is scarce. As part of the Swiss-AF prospective cohort study, we aimed to characterise AF costs and their development over time, and to assess specific patient clusters and their cost trajectories.

Methods: Swiss-AF enrolled 2415 patients with variable duration of AF between 2014 and 2017. Patient clusters were identified using hierarchical cluster analysis of baseline characteristics. Ongoing yearly follow-ups include health insurance clinical and claims data. An algorithm was developed to adjudicate costs to AF and related complications.

Results: A subpopulation of 1024 Swiss-AF patients with available claims data was followed up for a median (IQR) of 3.24 (1.09) years. Average yearly AF-adjudicated costs amounted to SFr5679 (€5163), remaining stable across the observation period. AF-adjudicated costs consisted mainly of inpatient and outpatient AF treatment costs (SFr4078; €3707), followed by costs of bleeding (SFr696; €633) and heart failure (SFr494; €449). Hierarchical analysis identified three patient clusters: cardiovascular (CV; N=253 with claims), isolated-symptomatic (IS; N=586) and severely morbid without cardiovascular disease (SM; N=185). The CV cluster and SM cluster depicted similarly high costs across all cost outcomes; IS patients accrued the lowest costs.

Conclusion: Our results highlight three well-defined patient clusters with specific costs that could be used for stratification in both clinical and economic studies. Patient characteristics associated with adjudicated costs as well as cost trajectories may enable an early understanding of the magnitude of upcoming AF-related healthcare costs.

Keywords: Atrial Fibrillation; Health Care Economics and Organizations.

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Conflict of interest statement

Competing interests: AA is a consultant with Abbott, Boston Scientific, Backbeat, Cairdac, Corvia, EP Solutions, Medtronic, Microport CRM, Philips and XSpline; participates in clinical trials sponsored by Boston Scientific, Medtronic, Microport CRM, Philips and XSpline; and has intellectual properties assigned to Boston Scientific, Biosense Webster and Microport CRM. JHB reports grant support from the Swiss National Foundation of Science, the Swiss Heart Foundation and the Stiftung Kardio; grant support, speakers and consultation fees to the institution from Bayer, Sanofi and Daiichi Sankyo. DC received consulting fees from Roche Diagnostics, and speaker fees from Servier and BMS/Pfizer, all outside of the current work. MK reports personal fees from Bayer, personal fees from Böhringer Ingelheim, personal fees from Pfizer/BMS, personal fees from Daiichi Sankyo, personal fees from Medtronic, personal fees from Biotronik, personal fees from Boston Scientific, personal fees from Johnson&Johnson, personal fees from Roche, grants from Bayer, grants from Pfizer, grants from Boston Scientific, grants from BMS, grants from Biotronik and grants from Daiichi Sankyo. GM has received consultant fees for taking part in advisory boards from Novartis, Boehringer Ingelheim, Bayer, AstraZeneca and Daiichi Sankyo, all outside of the presented work. AM reports fellowship and training support from Biotronik, Boston Scientific, Medtronic, Abbott/St Jude Medical and Biosense Webster; speaker honoraria from Biosense Webster, Medtronic, Abbott/St Jude Medical, AstraZeneca, Daiichi Sankyo, Biotronik, MicroPort and Novartis; and consultant honoraria for Biosense Webster, Medtronic, Abbott/St Jude Medical and Biotronik. TR has received research grants from the Swiss National Science Foundation, the Swiss Heart Foundation and the sitem insel support fund, all for work outside the submitted study; speaker/consulting honoraria or travel support from Abbott/SJM, AstraZeneca, Brahms, Bayer, Biosense Webster, Biotronik, Boston Scientific, Daiichi Sankyo, Medtronic, Pfizer/BMS and Roche, all for work outside the submitted study; support for his institution’s fellowship programme from Abbott/SJM, Biosense Webster, Biotronik, Boston Scientific and Medtronic for work outside the submitted study. MS reports grants from the Swiss National Science Foundation, for the conduct of the study; grants from Amgen, grants from MSD, grants from Novartis, grants from Pfizer, grants from Roche, grants and personal fees from BMS and personal fees from Sandoz, all outside the submitted work. MS-B reports grants from the European Commission outside of the present work. CS has received speaker honoraria from Biosense Webster and Medtronic and research grants from Biosense Webster, Daiichi Sankyo and Medtronic. The remaining authors have nothing to disclose.

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Patient clusters and cost trajectories in the Swiss Atrial Fibrillation cohort

Affiliations

Patient clusters and cost trajectories in the Swiss Atrial Fibrillation cohort

Authors

Affiliations

Abstract

Conflict of interest statement

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