title: Health care burden of dyspepsia among nonvalvular atrial fibrillation patients.
abstract: BACKGROUND
  Although dyspepsia is common among nonvalvular atrial fibrillation (NVAF) patients, its impact on patient health and cost has not been adequately studied.
  
  
  OBJECTIVE
  To evaluate the incremental health care burden associated with dyspepsia among NVAF patients and its impact on warfarin treatment.
  
  
  METHODS
  NVAF patients ≥ 18 years of age with continuous insurance coverage were identified (January 1, 2007, to December 31, 2009) from the MarketScan Commercial and Medicare Research databases. Patients with 1 inpatient or 2 outpatient dyspepsia diagnoses within 12 months following any NVAF diagnosis were grouped into the dyspeptic cohort, and patients without any dyspepsia diagnosis were grouped into the nondyspeptic cohort. Of the overall cohorts, patients were matched by key patient characteristics. Dyspepsia was further categorized as having a prior history of dyspepsia (chronic) or no dyspepsia (nonchronic) during the baseline period. Health care resource utilization, associated costs, and warfarin use were evaluated during a 12-month follow-up period.
  
  
  RESULTS
  Of NVAF patients included in the study (N = 142,322), 10.4% were diagnosed with dyspepsia. After matching for key characteristics, NVAF patients with dyspepsia had significantly greater inpatient, outpatient, and prescription claims per patient year than those without dyspepsia (1.24 ± 1.21 vs. 0.36 ± 0.68, P < 0.0001; 110.18 ± 101.03 vs. 66.98 ± 72.43, P < 0.0001; and 52.13 ± 35.30 vs. 44.29 ± 32.41, P < 0.0001, respectively). This greater number of claims was reflected in higher annual inpatient, outpatient, and prescription payments ($23,610 ± $54,748 vs. $5,509 ± $19,142, P < 0.0001; $18,182 ± $28,790 vs. $9,765 ± $22,009, P < 0.0001; and $4,661 ± $5,628 vs. $3,897 ± $4,586, P < 0.0001, respectively). NVAF patients with chronic dyspepsia were the least likely to take warfarin for stroke prevention.
  
  
  CONCLUSIONS
  NVAF patients with dyspepsia experienced more all-cause hospitalizations and required more outpatient medical services, all associated with greater expenditures than NVAF patients without dyspepsia. Additionally, dyspepsia may be a barrier to warfarin use among NVAF patients.
authors.affiliation: Rhode Island and Miriam Hospitals, 593 Eddy St., APC 739, Providence, RI 02903, USA. mkim4@lifespan.org.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Kim
authors.forename: Kelly F
authors.initials: KF
authors.lastname: Bell
authors.forename: Dinara
authors.initials: D
authors.lastname: Makenbaeva
authors.forename: Daniel
authors.initials: D
authors.lastname: Wiederkehr
authors.forename: Jay
authors.initials: J
authors.lastname: Lin
authors.forename: John
authors.initials: J
authors.lastname: Graham
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology*; D017281:Cost of Illness; D016208:Databases, Factual; D004415:Dyspepsia / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D055553:Prescription Drugs / Q000008:administration & dosage / Q000191:economics; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D014859:Warfarin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D055553:Prescription Drugs; D014859:Warfarin