Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Value Health. 2012 Mar-Apr;15(2):240-8. doi: 10.1016/j.jval.2011.09.009. Epub 2011 Dec 15.
To systematically review and synthesize the literature on the costs of atrial fibrillation (AF) with attention to study design and costing methods, geography, and intervention approaches.
A systematic search for previously published studies reporting the costs for AF patients was conducted. Data were analyzed in three steps: first by evaluating overall system costs; second by evaluating the relative contribution of specific cost components; and third by examining variations across study designs, across primary treatment approach, and by geography. Finally, a specific review of the treatment costs associated with anticoagulation treatment was examined given the clinical importance and attention given to these costs in the literature.
The literature search resulted in 115 articles. On review of the abstracts or full text of these articles, 21 articles met all study criteria and reported on health system AF-related direct costs. A further six articles focused exclusively on anticoagulation costs for patients with AF. The overall average annual system cost across 27 estimates obtained from the literature was $5450 (SD = $3624) in 2010 Canadian dollars and ranged from a low of $1,632 to a high of $21,099. About one-third of these costs could be attributed to anticoagulation management. The largest cost component was acute care, followed by outpatient and physician and then medication-related costs.
AF-related medical costs are high, reflecting resource-intensive and long-term treatments including anticoagulation treatment. These costs, accompanied with increasing prevalence, justify increased attention to the management of patients with AF. Future studies of AF cost should ensure a broad assessment of the incremental direct medical and societal cost associated with this diagnosis.
系统地回顾和综合有关心房颤动（AF）成本的文献，重点关注研究设计和成本核算方法、地理位置和干预方法。
系统地搜索了先前发表的报告 AF 患者成本的研究。数据分析分为三个步骤：首先评估总体系统成本；其次评估特定成本构成的相对贡献；最后考察研究设计、主要治疗方法和地理位置的差异。最后，鉴于抗凝治疗的临床重要性和文献中对这些成本的关注，专门审查了与抗凝治疗相关的治疗成本。
文献检索产生了 115 篇文章。在审查这些文章的摘要或全文后，21 篇文章符合所有研究标准，并报告了与健康系统相关的 AF 直接成本。另有 6 篇文章专门关注 AF 患者的抗凝治疗成本。从文献中获得的 27 项估计中，总体平均年度系统成本为 2010 年加元 5450 美元（SD=3624 美元），范围从 1632 美元到 21099 美元不等。这些成本的约三分之一可归因于抗凝管理。最大的成本构成是急性护理，其次是门诊和医生，然后是药物相关成本。
与 AF 相关的医疗费用很高，反映了资源密集型和长期治疗，包括抗凝治疗。这些成本，加上不断增加的患病率，证明了需要更加关注 AF 患者的管理。未来关于 AF 成本的研究应确保广泛评估与该诊断相关的增量直接医疗和社会成本。
