title: Economic Burden of Undiagnosed Nonvalvular Atrial Fibrillation in the United States.
abstract: Atrial fibrillation (AF) may be clinically silent and therefore undiagnosed. To date, no estimates of the direct medical cost of undiagnosed AF exist. We estimated the United States (US) incremental cost burden of undiagnosed nonvalvular AF nationally using administrative claims data. To calculate the incremental costs of undiagnosed AF, we compared annual medical costs (in 2014 US Dollars) for patients with AF compared to propensity-matched controls and multiplied this by estimates of undiagnosed AF prevalence derived from the same data sources. The study population included US residents aged ≥18 years with 24 months of continuous enrollment drawn from 2 large administrative claims databases. Mean per capita medical spending for patients with AF aged from 18 to 64 year was $38,861 (95% confidence interval [CI] $35,781 to $41,950) compared to $28,506 (95% CI $28,409 to $28,603) for similar patients without AF (incremental cost difference $10,355, p <0.001); total spending for patients aged ≥65 years with AF was $25,322 (95% CI $25,049 to $25,595) compared to $21,706 (95% CI $21,563 to $21,849) for similar patients without AF (incremental cost difference $3,616, p <0.001). Using estimates of the US prevalence of undiagnosed AF (596,000) drawn from the same data, we estimated that the US incremental cost burden of undiagnosed nonvalvular AF is $3.1 billion (95% CI $2.7 to $3.7 billion). In conclusion, the direct medical costs for patients with undiagnosed AF are greater than patients with similar observable characteristics without AF and strategies to identify and treat patients with undiagnosed AF could lead to sizable reductions in stroke sequelae and associated costs.
authors.affiliation: Division of Cardiovascular Medicine, Stanford University Hospital, Stanford University School of Medicine, Palo Alto, California. Electronic address: mintu@stanford.edu.
authors.forename: Mintu P
authors.initials: MP
authors.lastname: Turakhia
authors.affiliation: Precision Health Economics, Los Angeles, California.
authors.forename: Jason
authors.initials: J
authors.lastname: Shafrin
authors.affiliation: Precision Health Economics, Los Angeles, California.
authors.forename: Katalin
authors.initials: K
authors.lastname: Bognar
authors.affiliation: Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, California.
authors.forename: Dana P
authors.initials: DP
authors.lastname: Goldman
authors.affiliation: Pfizer, Inc., New York, New York.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Mendys
authors.affiliation: Department of Medical Affairs, Pfizer, Inc., New York, New York.
authors.forename: Younos
authors.initials: Y
authors.lastname: Abdulsattar
authors.affiliation: Department of Global Health & Value, Outcomes & Evidence, Pfizer, Inc., New York, New York.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wiederkehr
authors.affiliation: Department of Policy, Pfizer, Inc., New York, New York.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Trocio
mesh_terms: D000293:Adolescent; D000328:Adult; D001281:Atrial Fibrillation / Q000191:economics* / Q000453:epidemiology / Q000209:etiology; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D003951:Diagnostic Errors / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006349:Heart Valve Diseases; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult