Abstract P292: The Economic Burden To Medicare Of Stroke Events In Atrial Fibrillation Populations With And Without Treatment

Abstract

Purpose: About 2.3 million in the US have atrial fibrillation (AF), a diagnosis which confers a 5-fold increased stroke risk. Prevention is paramount as AF-related strokes are often severe. Anticoagulation reduces the annual incidence of stroke in AF patients by 30–40%. However, anticoagulation is prescribed for only about half of appropriate AF patients. More strokes may be prevented with wider use of anticoagulation therapy. This study estimates the economic burden to Medicare of stroke events in AF cohorts, and the estimated economic implications of stroke reduction associated with increased anticoagulant prophylaxis among moderate to high risk stroke patients. Methods: We used a microcosting model to estimate the annual economic burden of ischemic and hemorrhagic strokes in a hypothetical Medicare AF population who were candidates for anticoagulation. The hypothetical AF population of 1,000 included 45% untreated, 10% on antiplatelet and 45% on anticoagulation therapy. AF prevalence, stroke risk (based on CHADS 2 ) and stroke risk-reduction were adjusted for age (≥ 65 yrs), comorbidities and anticoagulation/antiplatelet status. Annual incremental stroke-related healthcare costs were drawn from published literature and adjusted to 2010 US$. Results: The base case model estimated 132 ischemic strokes (21 fatal) and 49 hemorrhagic strokes (19 fatal) generating an estimated $12.25 million in stroke-related healthcare costs to Medicare. Keeping all other variables constant, a 10% increase in anticoagulant use from the untreated population would reduce ischemic stroke events by 12 (to 120; 19 fatal), hemorrhagic stroke events by 4 (to 44; 18 fatal), and stroke-related costs by more than $1 million. Conclusion: A 10% increase in anticoagulant use in a hypothetical AF cohort is expected to reduce stroke events, stroke-related fatalities and stroke-related costs by nearly 9%. Increased use of anticoagulation, with the potential to reduce the incidence of ischemic and hemorrhagic stroke, could significantly decrease stroke events, fatalities, and related healthcare costs.