title: Acute hospital, community, and indirect costs of stroke associated with atrial fibrillation: population-based study.
abstract: OBJECTIVE
  No economic data from population-based studies exist on acute or late hospital, community, and indirect costs of stroke associated with atrial fibrillation (AF-stroke). Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic agents.
  
  
  METHODS
  In a population-based prospective study of incident and recurrent stroke treated in hospital and community settings, we investigated direct (healthcare related) and indirect costs for a 2-year period. Survival, disability, poststroke residence, and healthcare use were determined at 90 days, 1 year, and 2 years. Acute hospital cost was determined using a case-mix approach, and other costs using a bottom-up approach (2007 prices).
  
  
  RESULTS
  In 568 patients ascertained in 1 year (2006), the total estimated 2-year cost was $33.84 million. In the overall sample, AF-stroke accounted for 31% (177) of patients, but a higher proportion of costs (40.5% of total and 45% of nursing home costs). On a per-patient basis compared with non-AF-stroke, AF-stroke was associated with higher total (P<0.001) and acute hospital costs (P<0.001), and greater nursing home (P=0.001) and general practitioner (P<0.001) costs among 90-day survivors. After stratification by stroke severity in survivors, AF was associated with 2-fold increase in costs in patients with mild-moderate (National Institutes of Health Stroke Scale, 0-15) stroke (P<0.001) but not in severe stroke (National Institutes of Health Stroke Scale ≥16; P=0.7).
  
  
  CONCLUSIONS
  In our population study, AF-stroke was associated with substantially higher total, acute hospital, nursing home, and general practitioner costs per patient. Targeted programs to identify AF and prevent AF-stroke may have significant economic benefits, in addition to health benefits.
authors.affiliation: From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.).
authors.forename: Niamh
authors.initials: N
authors.lastname: Hannon
authors.affiliation: From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.).
authors.forename: Leslie
authors.initials: L
authors.lastname: Daly
authors.affiliation: From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.).
authors.forename: Sean
authors.initials: S
authors.lastname: Murphy
authors.affiliation: From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.).
authors.forename: Samantha
authors.initials: S
authors.lastname: Smith
authors.affiliation: From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.).
authors.forename: Derek
authors.initials: D
authors.lastname: Hayden
authors.affiliation: From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.).
authors.forename: Danielle
authors.initials: D
authors.lastname: Ní Chróinín
authors.affiliation: From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.).
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Callaly
authors.affiliation: From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.).
authors.forename: Gillian
authors.initials: G
authors.lastname: Horgan
authors.affiliation: From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.).
authors.forename: Orla
authors.initials: O
authors.lastname: Sheehan
authors.affiliation: From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.).
authors.forename: Bahman
authors.initials: B
authors.lastname: Honari
authors.affiliation: From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.).
authors.forename: Joseph
authors.initials: J
authors.lastname: Duggan
authors.affiliation: From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.).
authors.forename: Lorraine
authors.initials: L
authors.lastname: Kyne
authors.affiliation: From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.).
authors.forename: Eamon
authors.initials: E
authors.lastname: Dolan
authors.affiliation: From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.).
authors.forename: David
authors.initials: D
authors.lastname: Williams
authors.affiliation: From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.).
authors.forename: Miriam
authors.initials: M
authors.lastname: Wiley
authors.affiliation: From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.). biovasc_projectteam@mater.ie.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kelly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000191:economics*; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D020521:Stroke / Q000150:complications* / Q000191:economics*
keywords: atrial fibrillation; healthcare economics and organizations; prevention and control; stroke