Cost of treatment failure: Medicare spending on stroke for atrial fibrillation patients not receiving anticoagulation

Abstract

BackgroundIt is well known that atrial fibrillation (AF) patients not receiving anticoagulants are at higher risk of Ischemic Stroke (IS). ObjectiveOur objective is to estimate how much the Medicare program spends during one-year treating a Medicare beneficiary (MB) with AF who were not being anticoagulated prior to or during their IS hospitalization. MethodsThis cross-sectional study population consisted of all MBs in the fee-for-service program who were discharged from a hospitalization for IS having AF during 2018. Patients were excluded for a prior history of stroke or already receiving long-term anticoagulants. Medicare spending was defined as paid claims during the index hospitalization and all facility claims that began within 12-months of the index hospital discharge date even if admission occurred in 2019. ResultsThe final sample was 50,509 MBs. Average Medicare Part A spending per beneficiary was $46,867 ± $49,212, for a total of nearly $2.5 billion. Highest average spending per MB was for hospital services $25,848, of which $15,790 ± $20,984 occurred during the index hospitalization, and $10,058 ± $21,956 for rehospitalization. The Medicare program average MB spending included $8131 ± $14,979 at skilled nursing facilities, $5538 ± $12,739 at rehabilitation facilities, and $3056 ± $7495 for outpatient facilities or emergency departments. ConclusionMBs with AF who are not treated with anticoagulants and then suffer an ischemic stroke result in one-year Medicare Part A program spending of approximately $47,000 per person compared to an average spending of approximately $12,800 per beneficiary in the Medicare program in 2018 [1]. Identification and anticoagulation treatment in AF could result in significant healthcare savings.