Abstract P102: Costs, Accessibility, and Utilization: Disparities in Anti-Arrhythmic Drug Use in Atrial Fibrillation Patients

Abstract

Background: Patients with atrial fibrillation (AF) have an increased risk of stroke, heart failure, and other cardiac-related complications. AF is recognized as a significant contributor to rising healthcare costs due to increased hospitalizations, medical visits, and medications. However, utilization and costs of anti-arrhythmic drugs (AADs) for AF treatment remain unknown. Methods: This cross-sectional study uses data from the Medical Expenditure Panel Survey for 2016-21 and includes AF patients prescribed Class I-V AADs. Our survey-weighted model calculates national estimates and adjusted odds ratios (OR) for associations between demographic factors, days of medication supplied, and out-of-pocket (OOP) cost. Results: Patients with AF were significantly more likely to receive the lowest decile of days’ supply of AADs (<85 days) if they were below age 60 (OR 4.93, p = 0.005) compared to patients older than age 80 or insured through only Medicare (OR 2.93, p = 0.023) or other federal or state insurances (OR 3.70, p = 0.007) compared to private insurance. Compared to patients with a family income of less than $15k per year, AF patients were significantly more likely to pay in the top decile for cost per day supply of AADs (91 cents/day) if they had a family income between $15-30K. AF patients with Medicaid were significantly less likely to pay in the top decile for cost per day supply of AADs (OR 0.19, p = 0.001) compared to patients with private insurance. Patients with AF underutilized AADs significantly more in 2021 compared to 2016 (OR 3.28, p = 0.029). Conclusions: Younger age and public insurance were associated with a lower days’ supply of AADs for AF patients. Patients with a family income around the typical state’s Medicaid income limit ($15-30K) pay significantly higher OOP costs for AADs. To increase AAD adherence, policies should aim to decrease AAD cost for patients marginally above public insurance income limits and to educate patients below age 60 on the importance of AADs in treating AF.