Cost-of-illness studies of atrial fibrillation: methodological considerations

Abstract

Atrial fibrillation (AF) is the most common heart rhythm arrhythmia, which has considerable economic consequences. This study aims to identify the current cost-of-illness estimates of AF; a focus was put on describing the studies’ methodology. A literature review was conducted. Twenty-eight cost-of-illness studies were identified. Cost-of-illness estimates exist for health insurance members, hospital and primary care populations. In addition, the cost of stroke in AF patients and the costs of post-operative AF were calculated. The methods used were heterogeneous, mostly studies calculated excess costs. The identified annual excess costs varied, even among studies from the USA (∼US$1900 to ∼US$19,000). While pointing toward considerable costs, the cost-of-illness studies’ relevance could be improved by focusing on subpopulations and treatment mixes. As possible starting points for subsequent economic studies, the methodology of cost-of-illness studies should be taken into account using methods, allowing stakeholders to find suitable studies and validate estimates.

Keywords::

• atrial fibrillation
• cost-of-illness
• decision support technique
• health economics
• review

Acknowledgements

The author would like to thank F Kirsch, who independently undertook the literature review for validation.

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Atrial fibrillation (AF) is the most common hearth rhythm disorder and has considerable economic impact.

• The term ‘cost-of-illness study’ labels a variety of methods that aim to calculate the additional costs due to to a particular health condition.

• Scientists and decision-makers need to take into account the methodological choices in cost-of-illness studies in order to assess their comparability and applicability to a given decsion context.

• The 28 identified cost-of-illness studies on AF were heterogeneous, mostly calculating the sum of AF-related healthcare resources, rather than excess costs.

• Mostly driven by the inpatient sector, the costs-of-illness of AF were high. Prevention efforts that aim at the prevention of inpatient costs appear as rewarding target for subsequent cost–effectiveness analyses.

• For the reviewed studies, the overall quality of reporting was good, except for a clear definition of the study perspective and the conducting of sensitivity analyses.

• The systematic approach to assess the cost-of-illness studies’ comparability proved feasible and pointed toward clusters of studies with a high comparability. However, standardization within study characteristics could enhance the cost-of-illness studies’ relevance.

• Researchers and decision-makers could use the methods provided in this review to find comparable studies. This could aid model development, by pointing toward complementing studies and validation, by finding similar studies.