Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany.
Value Health. 2009 Mar-Apr;12(2):293-301. doi: 10.1111/j.1524-4733.2008.00416.x. Epub 2008 Jul 24.
Atrial fibrillation (AF) is an increasing burden on health-care systems because of an aging population. This study aimed to estimate health-care resource use and costs of treating AF in Germany.
A 6-month multicenter prospective observational cohort study with additional 3-month retrospective clinical data collection was performed in physician practices. AF-related resource use was documented by 3-month retrospective and 6-month prospective clinical data from physician charts and prospectively by patient questionnaires at 3 and 6 months. Cost calculation was from the health-care payer perspective.
A total of 361 patients (mean age 71 +/- 9 years, 61% male) were recruited from 45 physician practices. Of 311 (86.1%) patients with complete data, 75% had persistent AF; oral anticoagulation and/or aspirin were prescribed in 98%. A rhythm-control strategy was applied in 27%, rate control in 58%, and 15% received neither antiarrhythmic medication nor cardioversion. A higher proportion of rhythm-control patients had paroxysmal AF (P < 0.001). Mean annual AF-related per-patient cost was 827 Euro +/- 1476 (median 386 Euro). 50% of total costs were incurred by 11% of patients, driven by AF-related hospitalizations (44%). Antiarrhythmics and stroke prophylaxis accounted for 20% and 15% of expenditures, respectively. Mean annualized costs were higher for rhythm-control patients than for rate-control patients or those without antiarrhythmic treatment (1572 vs. 780 vs. 544 Euro, P < 0.001).
This evaluation provides an overview of current treatment modalities and cost of AF management in Germany. Efforts to reduce the economic burden of AF should focus on avoidance of AF hospital admissions and optimization of stroke prevention and rhythm control.
由于人口老龄化，房颤（AF）给医疗保健系统带来的负担日益加重。本研究旨在评估德国治疗房颤的医疗资源利用情况和成本。
在医生诊所进行了一项为期 6 个月的多中心前瞻性观察队列研究，并进行了额外的 3 个月回顾性临床数据收集。通过 3 个月的回顾性和 6 个月的前瞻性临床数据从医生图表中记录房颤相关资源利用情况，并通过患者在 3 个月和 6 个月时的前瞻性问卷调查进行记录。成本计算从医保支付者的角度进行。
共从 45 家医生诊所招募了 361 名（平均年龄 71 +/- 9 岁，61%为男性）患者。在 311 名（86.1%）有完整数据的患者中，75%患有持续性房颤；98%的患者处方了口服抗凝药和/或阿司匹林。27%的患者采用节律控制策略，58%的患者采用心率控制策略，15%的患者既未接受抗心律失常药物治疗也未接受电复律。节律控制组患者阵发性房颤的比例更高（P < 0.001）。每位患者每年房颤相关的平均费用为 827 欧元 +/- 1476 欧元（中位数为 386 欧元）。50%的总费用由 11%的患者产生，这主要是由房颤相关的住院费用（44%）所致。抗心律失常药物和卒中预防分别占支出的 20%和 15%。节律控制组患者的年平均费用高于心率控制组或未接受抗心律失常治疗的患者（1572 欧元比 780 欧元比 544 欧元，P < 0.001）。
本评价提供了德国当前房颤治疗模式和管理成本的概述。减少房颤经济负担的努力应侧重于避免房颤住院和优化卒中预防和节律控制。
