title: Using Phase-Based Costing of Real-World Data to Inform Decision-Analytic Models for Atrial Fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF) poses a significant economic burden. An increasing number of interventions for AF require cost-effectiveness analysis with decision-analytic modeling to demonstrate value. However, high-quality cost estimates of AF that can be used to inform decision-analytic models are lacking.
  
  
  OBJECTIVE
  The objectives of this study were to determine whether phase-based costing methods are feasible and practical for informing decision-analytic models outside of oncology.
  
  
  METHODS
  Patients diagnosed with AF between 1 January 2003 and 30 June 2011 in Ontario, Canada were identified based on a hospital admission for AF using administrative data housed at the Institute for Clinical Evaluative Sciences. Patient observations were then divided into phases based on clinical events typically used for decision-analytic modeling (i.e., minor stroke/transient ischemic attack [TIA], moderate to severe ischemic stroke, myocardial infarction, extracranial hemorrhage [ECH], intracranial hemorrhage [ICH], multiple events, death from an event, or death from other causes). First 30-day and greater than 30-day costs of healthcare resources in each health state were estimated based on a validated methodology. All costs are reported in 2013 Canadian dollars (Can$) and from a healthcare payer perspective.
  
  
  RESULTS
  Patients (n = 109,002) with AF who did not experience a clinical event incurred costs of Can$1566 per 30 days, on average. The average 30-day cost of experiencing a fatal clinical event was Can$42,871, but the cost of dying from all other causes was much smaller (Can$12,800). The clinical events associated with the highest short-term costs were ICH (Can$22,347) and moderate to severe ischemic stroke (Can$19,937). The lowest short-term costs were due to minor ischemic stroke/TIA (Can$12,515) and ECH (Can$12,261). Patients who had experienced a moderate to severe ischemic stroke incurred the highest long-term costs.
  
  
  CONCLUSIONS
  Real-world Canadian data and a phase-based costing approach were used to estimate short- and long-term costs associated with AF-related major clinical events. The results of this study can also inform decision-analytic models for AF.
authors.affiliation: Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada. amytawfik1226@gmail.com.|Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada. amytawfik1226@gmail.com.
authors.forename: Amy
authors.initials: A
authors.lastname: Tawfik
authors.affiliation: Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.|Institute for Clinical Evaluative Sciences, Toronto Rehabilitation Institute, Toronto, ON, Canada.
authors.forename: Walter P
authors.initials: WP
authors.lastname: Wodchis
authors.affiliation: Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada.|Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada.
authors.forename: Petros
authors.initials: P
authors.lastname: Pechlivanoglou
authors.affiliation: Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada.|Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hoch
authors.affiliation: Institute of Health Economics, Edmonton, AB, Canada.
authors.forename: Don
authors.identifier: http://orcid.org/0000-0002-4416-6876
authors.initials: D
authors.lastname: Husereau
authors.affiliation: Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada.|Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada.
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000191:economics* / Q000401:mortality; D002423:Cause of Death; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000191:economics / Q000401:mortality; D002546:Ischemic Attack, Transient / Q000191:economics / Q000401:mortality; D008297:Male; D009203:Myocardial Infarction / Q000191:economics / Q000401:mortality; D009864:Ontario / Q000453:epidemiology; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D012307:Risk Factors; D020521:Stroke / Q000191:economics / Q000401:mortality