Variations in the costs of atrial fibrillation: a longitudinal study across 27 European and Central Asian countries
Authors: Walli-Attaei M , Luengo-Fernandez R , Gray A , Torbica A , Maggioni A P , Bairami F , Huculeci R , Aboyans V , Timmis A D , Vardas P , Leal J 
Published: November 2023

Abstract

Background/Introduction
For many conditions, disease complications are the main driver of care costs. Atrial fibrillation (AF) – the commonest manifestation of cardiac arrhythmia – increases the risk of stroke and coronary heart disease, both of which are costly. Although the clinical burden of AF is widely documented, it is unknown to what extent AF-related complications contribute to healthcare costs and if these costs vary across countries.

Purpose
To assess the individual patient healthcare costs associated with AF-related complications and their variation across 27 European and Central Asian countries.

Methods
We used data from the European Society of Cardiology’s Atrial Fibrillation General Registry, a prospective, multinational registry of 10,249 atrial fibrillation patients from 27 countries with two-years of annual follow-up. Information on patients’ clinical characteristics, healthcare visits, as well as diagnostic and interventional procedures were collected at each visit. Atrial fibrillation related complications were angina, non-ST-elevation myocardial infarction (NSTEMI), ST-elevation myocardial infarction (STEMI), thromboembolic events, haemorrhagic events, and new onset or worsening heart failure. All healthcare resource use (inpatient stays, outpatient visits, and medications) were costed using 2019 UK unit costs to better assess variations in overall resource use across countries. We used panel data methods to assess the association of AF-related complications and healthcare costs and resource use. The models were adjusted for patients’ clinical and sociodemographic characteristics, prior medication use and geographical location.

Results
Over the follow-up period, 745 (8%) patients had an AF-related complication at 12-months and 477 (6%) at 24-months. Of the total 1,222 complications, the most common AF-related complication was new onset or worsening heart failure which occurred in 567 (3%) patients with complications. Overall, angina (£2,629, 95% CI: 1869 to 3361) and haemorrhagic events (£2,549, £2,199 to £2,900) incurred the highest cost, whereas non-stable myocardial infarction (£1,367, £687 to £2,048) incurred the least additional cost. We found significant regional variation. Costs of angina in Eastern EU and in non-EU former Soviet republics were, respectively, £1,362 (-£2,262 to -£461) and £1,416 (-£2,571 to -£261) lower than in Western Europe. Whereas costs in Southern EU and Northern EU countries were £721 (-£2,629 to £1,186) and £344 (-£1,460 to £ 674) lower than in Western Europe.

Conclusions
Although disease complications are costly in all countries, notable differences were observed across countries. These differences were driven by fewer investigations, clinic visits, and ER admissions. Our results, therefore, highlight the regional variations in resource use patterns across countries, limiting the generalisability of country-specific economic evaluations to other jurisdictions.