gms | German Medical Science

21. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

05.10. - 07.10.2022, Potsdam

Cost of illness of high risk for stroke and bleeding in patients with atrial fibrillation

Meeting Abstract

  • Eric Faß - Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung (WIG2), Leipzig, Deutschland
  • Marco Müller - Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung (WIG2), Leipzig, Deutschland
  • Franziska Claus - Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung (WIG2), Leipzig, Deutschland
  • Ulf Landmesser - Charité-Universitätsmedizin Berlin, Medizinische Klinik für Kardiologie (CBF), Berlin, Deutschland
  • Ines Weinhold - Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung (WIG2), Leipzig, Deutschland

21. Deutscher Kongress für Versorgungsforschung (DKVF). Potsdam, 05.-07.10.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. Doc22dkvf381

doi: 10.3205/22dkvf381, urn:nbn:de:0183-22dkvf3810

Veröffentlicht: 30. September 2022

© 2022 Faß et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Background and status of (inter)national research: Atrial fibrillation (AF) is one of the most frequent cardiac disorders, associated with increased stroke risk, mortality, and hospitalization rates. Due to demographic ageing, increasing AF-prevalence as well as associated healthcare costs are expected. Although oral anticoagulants (OACs) and novel oral anticoagulants (NOACs) can prevent stroke effectively, they are contraindicated for some patients with certain risk factors, due to increased drug-induced risk of severe bleeding. Percutaneous catheter-based left atrial appendage closure (LAAC) is a potential alternative for stroke prevention and can eliminate the need for permanent blood thinners, especially in this high-risk group. Even though evidence regarding effectiveness of LAAC exists, more research in high-risk AF patients is needed. The multicenter clinical trial CLOSURE-AF-DZHK16 closes this research gap, by analyzing the net clinical benefit of LAAC in this high-risk group compared to the best possible medical therapy (including NOAC, when feasible). The associated substudy EvaClosure focuses on the health economic evaluation of LAAC.

Research question and objective: This cost-of-illness study is the first part of EvaClosure, analyzing healthcare costs and resource utilization of AF patients with high risk of stroke and bleeding compared to AF patients without this high risk from statutory health insurance (SHI) perspective, needed due to increased prevalence of AF and associated costs.

Method or hypothesis: We assess the high-risk cost-of illness from a SHI perspective in a retrospective controlled study by using longitudinal data from a large German SHI (N > 3.2 million). Patients with AF at baseline (2015), but without a high risk of stroke (CHA2DS2VASc-Score ≥ 2) and bleeding (HAS-BLED-Score ≥ 3) are identified. The high risk can only be developed in the observation period (2016–2018). Differences in healthcare costs between the high-risk group and a propensity-matched non-high-risk control group with similar age, gender, comorbidity, and cost profiles at baseline are analyzed in a 2-year follow-up (2019–2020). Costs are captured on outpatient services, inpatient care, drug expenditures and medical aids. A difference-in-differences estimation is used to account for group-specific differences due to unobserved heterogeneity and median regression models are applied.

Results: Propensity score matching results in non-significant group differences in healthcare costs and other characteristics at baseline. The difference-in-differences analysis in the median regression yields a significant estimate of 721.89 €.

Discussion: AF patients with high risk of stroke and bleeding cause significantly more healthcare costs, emphasizing the economic burden related to the high risk.

Practical implications: The results highlight the need for further research regarding crucial cost drivers and healthcare costs associated with the high risk, as well as suitable prevention programs.

Appeal for practice (science and/or care) in one sentence: Due to the study design and empirical strategy, this analysis provides more robust cost measures, needed for more specific identification of economic burden.

Funding: Innovationsfonds/Versorgungsforschung; 01VSF19049