Implications of stroke and bleeding risk scores and comorbidities on episode-based bundled payments for patients with nonvalvular atrial fibrillation

Abstract

Objectives: Due to the high cost of nonvalvular atrial fibrillation (NVAF), this condition may be a suitable candidate for condition-specific bundled payments. This paper evaluates the healthcare cost of NVAF and uses common bleeding and stroke risk scores (HAS-BLED and CHA₂DS₂-VASc) to explore the risk-based healthcare cost differences among NVAF patients.

Methods: MarketScan claims of NVAF patients (ICD-9-CM code 427.31) were analyzed from January 2010 to April 2015. These claims feature more than 196 million covered lives and more than 300 contributing employers and 25 contributing health plans. A retrospective cohort design was used to assess episodes of care costs among patients with NVAF. Previously and newly diagnosed NVAF patients were selected from adult patients with ≥2 diagnoses of NVAF, and without valvular disease. Total all-cause healthcare costs at 1 year were stratified by stroke (CHA₂DS₂-VASc) and bleeding (HAS-BLED) risk scores. Study data was extracted in the MarketScan Commercial Claims and Encounters Database (Commercial Database) and the MarketScan Medicare Supplemental and Coordination of Benefits Database (Medicare Supplemental Database).

Results: Mean all-cause 1 year cost of care based on stroke risk (CHA₂DS₂-VASc) varied from $15,703 to $59,163 for previously diagnosed and $25,992 to $62,458 for newly diagnosed NVAF. Similarly, mean cost varied base on bleeding risk (HAS-BLED) for previously and newly diagnosed NVAF from $17,950 to $57,029 and $26,356 to $67,104 respectively.

Conclusion: NVAF patients accrue variable healthcare costs. Stroke and bleeding risk should be taken into account during the creation of NVAF payment bundles.

Keywords:

• Nonvalvular atrial fibrillation
• stroke
• major bleeding
• health costs
• bundled payments

Transparency

Declaration of funding

Three of the authors (Laliberté, Brown, and Lefebvre) are employees of Analysis Group Inc., a consulting company that has received research grants from Janssen Scientific Affairs LLC.

Author contributions: All authors were involved in the conception and design of the study, analysis and interpretation of data, drafting/editing of the manuscript and final approval. All authors agree to be accountable for all aspects of the work.

Declaration of financial/other relationships

F.L., K.B. and P.L. have disclosed that they are employees of Analysis Group Inc., a consulting company that has received research grants from Janssen Scientific Affairs LLC. B.B. and J.S. have disclosed that they are employees of Janssen Scientific Affairs LLC. W.W.N. has disclosed that at the time the study was conducted she was an employee of Janssen Scientific Affairs LLC. S.M. has disclosed that he is an employee of Johnson & Johnson Health Care Systems. S.K. and C.I.C. have disclosed that they received consulting fees from Janssen Scientific Affairs, LLC.

A CMRO peer reviewer on the manuscript declares that they work as a medical officer at The Centers for Medicare and Medicaid Services (CMS) and works on the Oncology Care Model, an episode-based payment model. All other CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.