title: Estimation of total incremental health care costs in patients with atrial fibrillation in the United States.
abstract: BACKGROUND
  Detailed information on the cost burden of atrial fibrillation (AF) is limited. To provide an up-to-date estimate of the national cost of AF, we conducted a retrospective, observational cohort study using administrative claims from the MarketScan Commercial and Medicare Supplemental research data bases, 2004 to 2006.
  
  
  RESULTS
  Patients aged ≥20 years with ≥1 inpatient or ≥2 outpatient AF diagnoses in 2005 (first diagnosis=index) and ≥12 months' enrollment before and after index were selected. AF patients were propensity score-matched (1:1) with non-AF control subjects. Medical costs (2008 US$), including AF costs, other cardiovascular, and noncardiovascular costs, were examined over 1 year after index. National incremental costs of AF were based on age-/sex-specific AF prevalence projections for 2010. In total, 89 066 AF patients were matched to non-AF control subjects. Over 1 year, 37.5% of AF versus 17.5% of control subjects were hospitalized and 2.1% versus 0.1% died during hospitalization. For AF versus control subjects, mean annual inpatient costs per patient were $7841 versus $2622 (incremental cost, $5218), outpatient medical costs were $9225 versus $5629 ($3596), and outpatient pharmacy costs were $3605 versus $3714 (-$109) (all P<0.001). The total incremental cost of AF was $8705 per patient. The national incremental cost of AF was $26.0 billion (AF, $6.0 billion; other cardiovascular, $9.9 billion; noncardiovascular, $10.1 billion). Cardiovascular costs were based on claims with a primary disease diagnosis and may be underestimates.
  
  
  CONCLUSIONS
  On the basis of current US age- and sex-specific prevalence data, the national incremental AF cost is estimated to range from $6.0 to $26.0 billion.
authors.affiliation: Division of Cardiology, Northwestern University, Feinberg School of Medicine, 251 E Huron Street, Chicago, IL 60611, USA. michael.kim@nmff.org
authors.forename: Michael H
authors.initials: MH
authors.lastname: Kim
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Johnston
authors.forename: Bong-Chul
authors.initials: BC
authors.lastname: Chu
authors.forename: Mehul R
authors.initials: MR
authors.lastname: Dalal
authors.forename: Kathy L
authors.initials: KL
authors.lastname: Schulman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000191:economics* / Q000453:epidemiology*; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology