From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.).
Stroke. 2014 Dec;45(12):3670-4. doi: 10.1161/STROKEAHA.114.005960. Epub 2014 Oct 30.
No economic data from population-based studies exist on acute or late hospital, community, and indirect costs of stroke associated with atrial fibrillation (AF-stroke). Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic agents.
In a population-based prospective study of incident and recurrent stroke treated in hospital and community settings, we investigated direct (healthcare related) and indirect costs for a 2-year period. Survival, disability, poststroke residence, and healthcare use were determined at 90 days, 1 year, and 2 years. Acute hospital cost was determined using a case-mix approach, and other costs using a bottom-up approach (2007 prices).
In 568 patients ascertained in 1 year (2006), the total estimated 2-year cost was $33.84 million. In the overall sample, AF-stroke accounted for 31% (177) of patients, but a higher proportion of costs (40.5% of total and 45% of nursing home costs). On a per-patient basis compared with non-AF-stroke, AF-stroke was associated with higher total (P<0.001) and acute hospital costs (P<0.001), and greater nursing home (P=0.001) and general practitioner (P<0.001) costs among 90-day survivors. After stratification by stroke severity in survivors, AF was associated with 2-fold increase in costs in patients with mild-moderate (National Institutes of Health Stroke Scale, 0-15) stroke (P<0.001) but not in severe stroke (National Institutes of Health Stroke Scale ≥16; P=0.7).
In our population study, AF-stroke was associated with substantially higher total, acute hospital, nursing home, and general practitioner costs per patient. Targeted programs to identify AF and prevent AF-stroke may have significant economic benefits, in addition to health benefits.
目前尚无基于人群的研究针对房颤相关性卒中（AF-卒中）的急性期和晚期住院、社区和间接费用提供经济学数据。此类数据对于政策制定、服务规划和新治疗药物的成本效益分析至关重要。
在一项针对在医院和社区环境中治疗的新发和复发性卒中的基于人群的前瞻性研究中，我们调查了为期 2 年的直接（与医疗保健相关）和间接费用。在 90 天、1 年和 2 年时确定了生存、残疾、卒中后居住情况和医疗保健使用情况。采用病例组合方法确定急性期医院费用，采用自下而上的方法确定其他费用（2007 年价格）。
在 1 年内确定的 568 例患者中，总估计 2 年费用为 3384 万美元。在总体样本中，AF-卒中占 31%（177 例）的患者，但占较高比例的费用（占总成本的 40.5%，占疗养院费用的 45%）。与非 AF-卒中相比，AF-卒中患者的总费用（P<0.001）和急性期医院费用（P<0.001）更高，且 90 天存活者的疗养院（P=0.001）和全科医生（P<0.001）费用更高。在幸存者中按卒中严重程度分层后，AF 与轻度中度卒中（NIH 卒中量表 0-15）患者的费用增加 2 倍相关（P<0.001），但与严重卒中（NIH 卒中量表≥16；P=0.7）无关。
在我们的人群研究中，AF-卒中患者的总费用、急性期医院费用、疗养院费用和全科医生费用均显著更高。针对识别 AF 和预防 AF-卒中的靶向项目可能具有显著的经济效益，除了健康益处外。
