Atrial fibrillation burden of illness: epidemiology and annual economic impact

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND The totality of evidence on atrial fibrillation (AF) highlights its role in reducing the quality of life and increasing the risk of developing complications, which are responsible in a considerable increase in the consumption of health resources. PURPOSE Considering the high incidence and prevalence of AF, physicians should be aware of the burden of the disease to provide a timely and effective response. This analysis aims to calculate the annual economic impact of AF in Italy. METHOD A model was developed to assess the economic impact of AF including the probability of the related complications occurring. The number of patients affected by AF was computed by applying to the over-65 years old population residing in Italy on 1th January 2020 the prevalence by the international literature. The separate prevalence of paroxysmal, persistent and permanent AF was considered as well as % of patients with and without symptoms. As according to data coming from literature, the % of patients under treatment is unfortunately very low, thus the general assumption that AF patients were untreated was done. A literature review was then conducted to collect validated relative risk (%RR) for each AF complication. If present in literature, the direct healthcare costs per patient/year were included in the model or, alternatively, the DRG tariffs as a proxy. The actualized costs linked to all complications were then used to estimate the economic impact of AF patients from the Italian National Healthcare System perspective. RESULTS According to this analysis, AF is the most common cardiac arrhythmia and in Italy in 2020 affected approx. 1.018.128 people: 104.942 (65-69 ages); 187.437 (70-74 ages); 223.418 (75-79 ages); 307.406 (80-84 ages); 353.911 (85+ ages). Patients were subdivided by AF conditions: a total of 205.662 patients with paroxysmal AF (82.265 symptomatic), 247.405 patients with persistent AF (113.806 symptomatic) and 565.061 patients with permanent AF (79.109 symptomatic). This economic model estimated the number of events occurred and monetizes the healthcare resource use for the management of complications. The number of events yearly experienced was: 366.526 for any stroke, 1.354.110 for Dementia, 1.130.122 for Heart Failure, 671.964 for Chronic kidney disease,142.538 for Ischemic heart disease, 699.454 for Peripheral arterial disease. The total cost of patients, considering the burden of complications defined before, for 2020 was about 25 billion. This is probably an underestimation, as each patient could experience more than one complication and consequently their annual cost increases. CONCLUSIONS Our data confirm that the costs of AF complications have a considerable impact on resource consumption. Thus, in a context of a cost containment, measures to reduce both the risk of developing AF and the risk of making the disease worse are strongly needed.