Abstract

BackgroundUse of oral anticoagulation therapy in patients with atrial fibrillation (AF) involves a trade-off between a reduced risk of ischemic stroke and an increased risk of bleeding events. Different anticoagulation therapies have different safety profiles and data on the societal costs of both ischemic stroke and bleeding events are necessary for assessing the cost-effectiveness and budgetary impact of different treatment options. To our knowledge, no previous studies have estimated the societal costs of bleeding events in patients with AF.The objective of this study was to estimate the 3-years societal costs of first-incident intracranial, gastrointestinal and other major bleeding events in Danish patients with AF.MethodsThe study was an incidence-based cost-of-illness study carried out from a societal perspective and based on data from national Danish registries covering the period 2002-2012. Costs were estimated using a propensity score matching and multivariable regression analysis (first difference OLS) in a cohort design.ResultsAverage 3-years societal costs attributable to intracranial, gastrointestinal and other major bleeding events were 27,627, 17,868, and 12,384 EUR per patient, respectively (2015 prices). Existing evidence shows that the corresponding costs of ischemic stroke were 24,084 EUR per patient (2012 prices). The average costs of bleeding events did not differ between patients with AF who were on oral anticoagulation therapy prior to the event and patients who were not.ConclusionsThe societal costs attributable to major bleeding events in patients with AF are significant. Intracranial haemorrhages are most costly to society with average costs of similar magnitude as the costs of ischemic stroke. The average costs of gastrointestinal and other major bleeding events are lower than the costs of intracranial haemorrhages, but still substantial. Knowledge about the relative size of the costs of bleeding events compared to ischemic stroke in patients with AF constitutes valuable evidence for decisions-makers in Denmark as well as in other countries.

Highlights

  • Use of oral anticoagulation therapy in patients with atrial fibrillation (AF) involves a trade-off between a reduced risk of ischemic stroke and an increased risk of bleeding events

  • There were no significant imbalances between the bleeding and control groups with regard to the covariates used in the propensity score matching

  • The average costs of bleeding events did not differ between patients with AF who were on oral anticoagulation therapy prior to the event and patients who were not

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Summary

Introduction

Use of oral anticoagulation therapy in patients with atrial fibrillation (AF) involves a trade-off between a reduced risk of ischemic stroke and an increased risk of bleeding events. Making clinical decisions about the use oral anticoagulation therapy in patients with AF involves a trade-off as oral anticoagulation therapy reduces the risk of ischemic stroke but may increase the risk of bleeding events [5,6,7,8]. Estimates of the societal costs of both ischemic stroke and bleeding events in patients with AF are necessary for assessing the cost-effectiveness and budgetary impact of different treatment options, including oral anticoagulation therapy versus no therapy and various oral anticoagulation therapies with different safety profiles. No previous studies have estimated the societal costs of bleeding events (intracranial, gastrointestinal and other) in patients with AF, including both direct and indirect costs. Cost estimates of bleeding events in the general population may differ from the costs of bleeding events in patients with AF as evidence suggests that bleeding events associated with oral anticoagulant therapy are generally more severe [17]

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