Daily costs of hospitalization in non-valvular atrial fibrillation patients treated with anticoagulant therapy

Figures & data

Figure 1. Patient disposition.

Table 1. Patient demographics and clinical characteristics of NVAF patients.

Characteristics^a	All patients (n = 375,560)	Type of AF diagnosis
		Admitting/Primary (n = 67,017)	Secondary (n = 308,543)
Demographics
Age, mean [median] (SD)	73.8 [76.0] (12.4)	67.9 [69.0] (14.4)	75.0 [77.0] (11.5)
Gender, female, n (%)	173,943 (46.3%)	30,561 (45.6%)	143,382 (46.5%)
Marital status, n (%)
Married	160,141 (42.6%)	31,980 (47.7%)	128,161 (41.5%)
Single	169,521 (45.1%)	27,243 (40.7%)	142,278 (46.1%)
Other/unknown	45,898 (12.2%)	7794 (11.6%)	38,104 (12.3%)
Ethnicity, n (%)
White	277,419 (73.9%)	49,675 (74.1%)	227,744 (73.8%)
Black	26,692 (7.1%)	4797 (7.2%)	21,895 (7.1%)
Other/Unknown	71,449 (19.0%)	12,545 (18.7%)	58,904 (19.1%)
Primary payer type, n (%)
Medicare	282,111 (75.1%)	39,599 (59.1%)	242,512 (78.6%)
Managed Care	47,345 (12.6%)	15,546 (23.2%)	31,799 (10.3%)
Commercial indemnity	14,850 (4.0%)	4170 (6.2%)	10,680 (3.5%)
Medicaid	12,581 (3.3%)	2574 (3.8%)	10,007 (3.2%)
Other/Unknown	18,673 (5.0%)	5128 (7.7%)	13,545 (4.4%)
Region of hospital, n (%)
Northeast	99,950 (26.6%)	18,601 (27.8%)	81,349 (26.4%)
Midwest	67,167 (17.9%)	12,127 (18.1%)	55,040 (17.8%)
West	60,207 (16.0%)	9196 (13.7%)	51,011 (16.5%)
South	148,236 (39.5%)	27,093 (40.4%)	121,143 (39.3%)
Hospital characteristics, n (%)
Urban (vs rural)	341,277 (90.9%)	60,335 (90.0%)	280,942 (91.1%)
Large (≥500 beds)	127,768 (34.0%)	22,469 (33.5%)	105,299 (34.1%)
Teaching	162,301 (43.2%)	27,715 (41.4%)	134,586 (43.6%)
Admitting physician specialty, n (%)
Cardiology	49,452 (13.2%)	16,907 (25.2%)	32,545 (10.5%)
Internal medicine (Internist)	185,841 (49.5%)	34,266 (51.1%)	151,575 (49.1%)
Family/General medicine	33,888 (9.0%)	7472 (11.1%)	26,416 (8.6%)
Surgery general	24,223 (6.4%)	328 (0.5%)	23,895 (7.7%)
Other/Unknown	82,156 (21.9%)	8044 (12.0%)	74,112 (24.0%)
Admission source, n (%)
Physician referral	187,783 (50.0%)	35,659 (53.2%)	152,124 (49.3%)
Clinical referral	15,190 (4.0%)	3311 (4.9%)	11,879 (3.9%)
Transfer from hospital	35,145 (9.4%)	3414 (5.1%)	31,731 (10.3%)
Other source	137,442 (36.6%)	24,633 (36.8%)	112,809 (36.6%)
Admission site, n (%)
Emergency room	201,212 (53.6%)	41,021 (61.2%)	160,191 (51.9%)
Intensive care unit	77,724 (20.7%)	10,455 (15.6%)	67,269 (21.8%)
Other site	96,624 (25.7%)	15,541 (23.2%)	81,083 (26.3%)
Degree of severity,^b n (%)
Minor	37,135 (9.9%)	20,526 (30.6%)	16,609 (5.4%)
Moderate	124,760 (33.2%)	27,038 (40.3%)	97,722 (31.7%)
Major	142,807 (38.0%)	15,888 (23.7%)	126,919 (41.1%)
Extreme	70,858 (18.9%)	3565 (5.3%)	67,293 (21.8%)
Year of index date, n (%)
2009	121,124 (32.3%)	21,240 (31.7%)	99,884 (32.4%)
2010	72,361 (19.3%)	13,400 (20.0%)	58,961 (19.1%)
2011	77,081 (20.5%)	13,217 (19.7%)	63,864 (20.7%)
2012	87,273 (23.2%)	15,942 (23.8%)	71,331 (23.1%)
2013	17,721 (4.7%)	3218 (4.8%)	14,503 (4.7%)

SD, standard deviation; NVAF, non-valvular atrial fibrillation; AF, atrial fibrillation.

^aEvaluated during index hospitalization stay.

^bSeverity level for the admission diagnosis-related group, as defined by 3M’s algorithm (APR-DRG grouper code).

Table 2. Length of stay and treatment characteristics of NVAF patients.

Treatment characteristics^a	All patients (n = 375,560)	Type of AF diagnosis
		Admitting/Primary (n = 67,017)	Secondary (n = 308,543)
Length of stay, mean [median] (SD)	6.8 [5] (8.5)	3.7 [3] (4.3)	7.5 [5] (9.1)
Percentage of patients with an ICU stay, n (%)	111,469 (29.7%)	12,364 (18.4%)	99,105 (32.1%)
Number of days in ICU, mean [median] (SD)	1.5 [0] (4.5)	0.5 [0] (1.9)	1.8 [0] (4.8)
Medication used, mean [median] (SD)
Number of different medications	9.9 [10] (4.9)	8.1 [8] (4.2)	10.3 [10] (5.0)
Number of doses per day
Oral	12.6 [11.3] (11.7)	12.0 [10.7] (9.1)	12.8 [11.5] (12.1)
Injections	5.2 [4] (3.9)	4.5 [4] (3.2)	5.4 [5] (4.0)
Days to anticoagulant administration, mean [median] (SD)	1.9 [1] (2.0)	1.4 [1] (1.0)	2.0 [1] (2.2)
Administration of anticoagulant therapy on day 3 or later, n (%)	62,972 (16.8%)	3746 (5.6%)	59,226 (19.2%)
Anticoagulant agent(s) administered on the first day of anticoagulant therapy,^b n (%)
Warfarin	122,093 (32.5%)	23,133 (34.5%)	98,960 (32.1%)
Unfractionated heparin	139,325 (37.1%)	22,105 (33.0%)	117,220 (38.0%)
Low molecular weight heparins	150,591 (40.1%)	34,290 (51.2%)	116,301 (37.7%)
Other	16,728 (4.5%)	3095 (4.6%)	13,633 (4.4%)

SD, standard deviation; NVAF, non-valvular atrial fibrillation; ICU, intensive care unit; AF, atrial fibrillation.

^aEvaluated during index hospitalization stay.

^bThe Premier Perspective Comparative Hospital Database does not provide the anticoagulant administration sequence within the same day. Therefore, if two or more agents were administered the same day it was not possible to identify which one was administered first.

Figure 2. Daily hospitalization costs of all NVAF patients stratified by cost categories during the first 14 days. NVAF, non-valvular atrial fibrillation.

Table 3. Daily hospitalization costs of NVAF patients.

	Day(s)	n	Mean (SD)
			All costs	Room and board costs^a	Nursing costs^a	Surgery costs^a	Supply costs^a	Laboratory costs^a	Pharmacy costs^a	Other costs
All patients	1	375,560	$4282 (6363)	$1151 (1123)	$45 (169)	$450 (2185)	$899 (3641)	$227 (245)	$264 (1482)	$1245 (1927)
	2	371,828	$2531 (3947)*	$1035 (913)*	$27 (177)*	$205 (1499)*	$321 (2025)*	$149 (191)*	$222 (889)	$572 (1056)*
	3	334,353	$2103 (3261)*	$975 (871)	$25 (173)	$147 (1094)	$242 (1674)	$102 (150)*	$193 (663)	$418 (873)*
	4	286,220	$1993 (3 397)	$935 (872)	$24 (170)	$135 (1083)	$232 (1846)	$92 (281)	$192 (869)	$383 (822)
	5	233,283	$1969 (3252)	$945 (879)	$24 (173)	$132 (1160)	$216 (1757)	$89 (144)	$197 (544)	$366 (775)
	6	191,108	$1959 (3339)	$958 (897)	$24 (175)	$123 (1144)	$210 (1961)	$87 (136)	$202 (659)	$355 (712)
	7	157,374	$1977 (3430)	$965 (909)	$25 (179)	$118 (982)	$210 (1958)	$87 (146)	$210 (833)	$363 (813)
	8–14^b	129,693	$2014 (47)	$1020 (33)	$27 (2)	$91 (12)	$167 (19)	$88 (1)	$240 (16)	$381 (14)
	15–30^b	40,683	$2231 (72)	$1142 (39)	$36 (4)	$75 (8)	$131 (14)	$93 (2)	$311 (24)	$443 (19)
	>30^c	6354	$2045 (2411)	$1024 (1147)	$38 (226)	$55 (218)	$115 (442)	$84 (131)	$305 (598)	$423 (542)
	Overall^c	375,560	$2391 (2227)	$889 (702)	$26 (130)	$171 (527)	$407 (1367)	$122 (107)	$191 (368)	$584 (756)
	Total^d	375,560	$18,631 (27,096)	$7981 (12 877)	$233 (2493)	$1303 (3775)	$2335 (6257)	$901 (1349)	$1801 (6827)	$4078 (6245)
Patients with an admitting/ primary NVAF diagnosis	1	67,017	$3332 (5242)	$1104 (960)	$48 (133)	$63 (755)	$560 (2803)	$221 (247)	$160 (305)	$1176 (2817)
	2	65,324	$1810 (2735)*	$826 (817)*	$24 (146)*	$39 (643)	$177 (1493)*	$129 (211)*	$144 (258)	$470 (1062)*
	3	50,097	$1505 (2465)*	$740 (782)*	$22 (147)	$36 (417)	$166 (1 570)	$73 (95)*	$126 (263)	$341 (867)*
	4	35,056	$1476 (2639)	$717 (726)	$21 (135)	$45 (525)	$184 (1 613)	$67 (85)	$124 (255)	$318 (1060)
	5	23,860	$1530 (2768)	$743 (768)	$18 (140)	$62 (688)	$217 (1 729)	$67 (89)	$126 (299)	$297 (838)
	6	16,628	$1554 (2894)	$763 (794)	$18 (125)	$62 (647)	$233 (1 953)	$68 (104)	$129 (335)	$281 (766)
	7	11,818	$1594 (3377)	$773 (790)	$18 (134)	$65 (725)	$257 (2 314)	$68 (96)	$136 (421)	$278 (777)
	8–14^b	8444	$1744 (93)	$871 (57)	$18 (1)	$71 (12)	$232 (41)	$74 (3)	$172 (23)	$307 (17)
	15–30^b	1404	$1 951 (193)	$1033 (80)	$26 (4)	$60 (24)	$143 (66)	$79 (6)	$250 (31)	$360 (59)
	>30^c	145	$1738 (1314)	$899 (643)	$25 (181)	$36 (94)	$98 (277)	$75 (85)	$254 (347)	$350 (429)
	Overall^c	67,017	$2101 (2398)	$776 (562)	$29 (114)	$46 (361)	$340 (1386)	$129 (122)	$133 (168)	$649 (1150)
	Total^d	67,017	$9273 (12,116)	$3963 (5603)	$126 (881)	$243 (1448)	$1263 (4381)	$533 (645)	$672 (1950)	$2472 (3949)
Patients with a secondary NVAF diagnosis	1	308,543	$4489 (6563)	$1161 (1155)	$45 (176)	$534 (2376)	$973 (3794)	$228 (245)	$287 (1627)	$1260 (1672)
	2	306,504	$2684 (4143)*	$1080 (926)	$27 (183)	$241 (1622)*	$351 (2120)*	$154 (187)*	$238 (971)	$593 (1053)*
	3	284,256	$2208 (3370)*	$1017 (879)	$25 (177)	$167 (1172)	$255 (1691)	$107 (157)*	$205 (710)	$432 (873)*
	4	251,164	$2065 (3484)	$965 (886)	$24 (174)	$147 (1139)	$239 (1877)	$96 (298)	$201 (923)	$392 (782)
	5	209,423	$2019 (3299)	$968 (887)	$25 (177)	$140 (1202)	$216 (1760)	$91 (149)	$205 (565)	$374 (767)
	6	174,480	$1998 (3375)	$976 (904)	$25 (179)	$129 (1180)	$208 (1962)	$89 (138)	$209 (682)	$362 (707)
	7	145,556	$2008 (3432)	$980 (916)	$25 (182)	$122 (999)	$206 (1927)	$88 (149)	$216 (858)	$370 (815)
	8–14^b	121,249	$2028 (44)	$1028 (30)	$28 (2)	$92 (12)	$164 (17)	$89 (1)	$243 (15)	$385 (14)
	15–30^b	39,279	$2239 (71)	$1145 (38)	$36 (4)	$76 (8)	$130 (13)	$93 (2)	$313 (24)	$445 (18)
	>30^c	6209	$2052 (2430)	$1027 (1156)	$38 (227)	$55 (220)	$115 (445)	$85 (132)	$306 (603)	$425 (544)
	Overall^c	308,543	$2455 (2183)	$914 (726)	$26 (133)	$198 (553)	$422 (1362)	$120 (103)	$204 (398)	$570 (638)
	Total^d	308,543	$20,664 (28,959)	$8853 (13812)	$256 (2719)	$1533 (4073)	$2568 (6572)	$981 (1445)	$2047 (7454)	$4427 (6588)

SD, standard deviation; NVAF, non-valvular atrial fibrillation.

*Denotes statistical difference (i.e., standardized difference >10%) to the preceding day.

^aCost stratifications were generated from the standardized charge master code categories of the billing information included in the Premier Perspective Comparative Hospital Database.

^bCalculated as the average of the mean daily cost of the days included in the period.

^cCalculated as the mean daily costs per patient.

^dCalculated as the mean total hospitalization costs per patient.

Table 4. Daily hospitalization pharmacy costs of NVAF patients.

	Day(s)	n	Mean (SD)
			All pharmacy costs	Anticoagulant costs^a			Hospital solution IV costs^a	Blood-related product costs^a	Anti-infective misc. costs^a	Penicillin costs^a	Other pharmacy costs
				All	Oral	Injectable^b
All patients	1	375,560	$264 (1482)	$33 (166)	$0.54 (2.33)	$32 (165)	$22 (82)	$17 (1 027)	$5 (43)	$4 (26)	$183 (1026)
	2	371,828	$222 (889)	$29 (123)	$0.75 (2.57)	$28 (123)	$22 (129)	$11 (715)	$7 (63)	$7 (30)	$146 (459)
	3	334,353	$193 (663)	$25 (118)	$0.74 (2.86)	$24 (117)	$19 (58)	$9 (485)	$7 (76)	$7 (30)	$126 (393)
	4	286,220	$192 (869)	$24 (104)	$0.70 (2.41)	$23 (103)	$18 (56)	$9 (547)	$8 (69)	$8 (34)	$126 (642)
	5	233,283	$197 (544)	$23 (126)	$0.67 (2.40)	$22 (125)	$18 (52)	$9 (329)	$8 (79)	$8 (32)	$130 (370)
	6	191,108	$202 (659)	$23 (114)	$0.64 (2.35)	$22 (114)	$18 (62)	$9 (459)	$9 (98)	$9 (34)	$133 (397)
	7	157,374	$210 (833)	$22 (116)	$0.61 (2.27)	$21 (115)	$19 (59)	$12 (709)	$10 (83)	$10 (36)	$138 (371)
	8–14^c	129,693	$240 (16)	$23 (1)	$0.55 (0.02)	$22 (1)	$20 (1)	$12 (1)	$14 (2)	$11 (0)	$160 (11)
	15–30^c	40,683	$311 (24)	$34 (5)	$0.46 (0.03)	$33 (5)	$23 (1)	$15 (3)	$23 (3)	$9 (1)	$207 (15)
	>30^d	6354	$305 (598)	$30 (195)	$0.42 (1.37)	$30 (195)	$21 (61)	$19 (303)	$24 (99)	$7 (27)	$204 (346)
	Overall^d	375,560	$191 (368)	$29 (88)	$0.74 (1.95)	$28 (88)	$17 (38)	$7 (238)	$6 (50)	$5 (20)	$127 (236)
	Total^e	375,560	$1801 (6827)	$206 (1495)	$4.83 (16.69)	$198 (1492)	$156 (521)	$95 (4916)	$83 (771)	$63 (261)	$1199 (3499)
Patients with an admitting/ primary NVAF diagnosis	1	67,017	$160 (305)	$42 (90)	$0.84 (2.96)	$41 (90)	$14 (31)	$1 (68)	$1 (12)	$1 (10)	$101 (265)
	2	65,324	$144 (258)	$45 (139)	$1.15 (3.26)*	$44 (138)	$10 (27)*	$1 (44)	$1 (16)	$1 (14)	$85 (195)
	3	50,097	$126 (263)	$38 (113)	$1.16 (3.11)	$37 (113)	$8 (24)	$1 (41)	$1 (17)	$2 (13)	$76 (216)
	4	35,056	$124 (255)	$36 (105)	$1.14 (3.36)	$34 (104)	$8 (25)	$1 (57)	$2 (19)	$2 (33)	$76 (204)
	5	23,860	$126 (299)	$34 (188)	$1.09 (2.98)	$33 (188)	$8 (26)	$2 (54)	$3 (24)	$3 (17)	$78 (202)
	6	16,628	$129 (335)	$33 (231)	$1.03 (3.20)	$32 (231)	$8 (27)	$2 (42)	$3 (42)	$3 (17)	$79 (214)
	7	11,818	$136 (421)	$30 (244)	$1.01 (3.13)	$29 (244)	$9 (29)	$4 (244)	$4 (29)	$4 (39)	$85 (208)
	8–14^c	8444	$172 (23)	$31 (5)	$0.79 (0.11)	$30 (5)	$13 (2)	$4 (1)	$8 (3)	$6 (1)	$110 (13)
	15–30^c	1404	$250 (31)	$44 (13)	$0.47 (0.17)	$43 (13)	$16 (2)	$14 (16)	$14 (3)	$7 (2)	$156 (22)
	>30^d	145	$254 (347)	$42 (233)	$0.37 (1.00)	$41 (233)	$16 (54)	$7 (26)	$17 (50)	$5 (19)	$167 (203)
	Overall^d	67,017	$133 (168)	$40 (80)	$1.05 (2.49)	$38 (80)	$10 (19)	$1 (26)	$1 (13)	$1 (10)	$80 (133)
	Total^e	67,017	$672 (1950)	$179 (1403)	$4.73 (13.01)	$173 (1403)	$48 (158)	$8 (368)	$12 (179)	$10 (104)	$414 (1007)
Patients with a secondary NVAF diagnosis	1	308,543	$287 (1627)	$31 (178)	$0.48 (2.16)	$30 (177)	$24 (89)	$21 (1132)	$6 (47)	$5 (28)	$201 (1124)
	2	306,504	$238 (971)	$25 (120)	$0.67 (2.39)	$24 (119)	$25 (141)	$14 (787)	$8 (69)	$8 (32)	$159 (496)
	3	284,256	$205 (710)	$23 (118)	$0.66 (2.81)	$22 (118)	$21 (62)	$11 (526)	$8 (82)	$8 (32)	$135 (416)
	4	251,164	$201 (923)	$22 (103)	$0.64 (2.24)	$21 (103)	$20 (59)	$10 (584)	$8 (74)	$9 (34)	$133 (681)
	5	209,423	$205 (565)	$22 (116)	$0.62 (2.32)	$21 (116)	$19 (54)	$10 (347)	$9 (82)	$9 (33)	$136 (384)
	6	174,480	$209 (682)	$22 (96)	$0.60 (2.25)	$21 (96)	$19 (64)	$10 (480)	$10 (102)	$10 (35)	$138 (410)
	7	145,556	$216 (858)	$21 (98)	$0.58 (2.19)	$20 (97)	$19 (61)	$12 (734)	$11 (86)	$10 (35)	$142 (381)
	8–14^c	121,249	$243 (15)	$23 (1)	$0.54 (0.02)	$22 (1)	$20 (1)	$12 (1)	$15 (2)	$11 (0)	$163 (11)
	15–30^c	39,279	$313 (24)	$34 (6)	$0.46 (0.03)	$33 (5)	$23 (1)	$16 (2)	$23 (3)	$9 (1)	$209 (14)
	>30^d	6209	$306 (603)	$30 (194)	$0.42 (1.38)	$29 (194)	$21 (62)	$19 (306)	$25 (100)	$7 (27)	$205 (349)
	Overall^d	308,543	$204 (398)	$27 (89)	$0.68 (1.81)	$26 (89)	$18 (41)	$9 (262)	$7 (55)	$6 (22)	$137 (252)
	Total^e	308,543	$2047 (7454)	$212 (1514)	$4.85 (17.39)	$204 (1511)	$180 (568)	$113 (5421)	$98 (846)	$74 (283)	$1369 (3810)

SD, standard deviation; NVAF, non-valvular atrial fibrillation; IV, intravenous.

*Denotes statistical difference (i.e., standardized difference >10%) to the preceding day.

^aCost stratifications were generated from the standardized charges master codes categories of the billing information included in the Premier Perspective Comparative Hospital Database.

^bIncludes heparins and heparin-like agents such as low molecular weight heparin and synthetic heparinoid.

^cCalculated as the average of the mean daily cost of the days included in the period.

^dCalculated as the mean daily costs per patient.

^eCalculated as the mean total hospitalization costs per patient.

Top 15 primary diagnoses of NVAF patients with AF as secondary diagnosis.

ICD-9-CM codes	Name	Number of patients	Frequency
428.xx	Heart failure	22,712	7.4%
038.xx	Septicemia	20,256	6.6%
410.xx	Acute myocardial infarction	19,006	6.2%
414.xx	Other forms of chronic ischemic heart disease	16,686	5.4%
434.xx	Occlusion of cerebral arteries	15,285	5.0%
486.xx	Pneumonia, organism unspecified	12,393	4.0%
427.xx	Cardiac dysrhythmias	11,983	3.9%
715.xx	Osteoarthrosis and allied disorders	9726	3.2%
820.xx	Fracture of neck of femur	9138	3.0%
518.xx	Other diseases of lung	7753	2.5%
V57.xx	Care involving use of rehabilitation procedures	7353	2.4%
491.xx	Chronic bronchitis	7049	2.3%
584.xx	Acute kidney failure	6442	2.1%
780.xx	General symptoms	5184	1.7%
996.xx	Complications peculiar to certain specified procedures	5147	1.7%