Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F Laboratory Block, Faculty of Medicine Building, 21 Sassoon Road, Hong Kong SAR, China.
Research Department of Practice and Policy, School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK.
Europace. 2017 Jun 1;19(6):937-947. doi: 10.1093/europace/euw093.
The aim of this study was to summarize healthcare costs incurred by patients with atrial fibrillation (AF) who developed ischaemic stroke, explore factors associated with increased cost, and highlight the importance of anticoagulation therapy for stroke prophylaxis. A systematic literature search of PubMed, EMBASE, Web of Science, and the health economic evaluation database was conducted up to December 2015. Studies focused on the cost and/or resource utilization of ischaemic stroke in patients with AF were included. Reported costs were converted to international dollars (I$) and adjusted to 2015 values. Alongside the narrative review of included studies, Spearman's correlation, independent-samples t-test, and one-way ANOVA were used to explore factors associated with cost differences between studies. Sixteen studies published from nine countries were identified. Based on currency conversion rates in 2015, ischaemic stroke-related healthcare costs were estimated to be I$41 420, I$12 895, and I$8184 for high-income, upper middle-income, and lower middle-income economies, respectively. Local GDP per capita accounted for ∼50% of the healthcare cost variation among countries. Major component of overall cost was from hospitalization. Ischaemic stroke incurring in patients with AF ≥75 years was 2.3 times that of their younger peers (P = 0.049). The economic burden from ischaemic stroke in patients with AF is considerable with positive association to country income. Clinicians and stakeholders should be aware of the importance of anticoagulation therapies in stroke prophylaxis, the occurrence of stroke, and the downstream economic burden on an increasingly ageing population.
本研究旨在总结发生缺血性脑卒中的房颤（AF）患者的医疗费用，探讨与费用增加相关的因素，并强调抗凝治疗对卒中预防的重要性。对 PubMed、EMBASE、Web of Science 和卫生经济评价数据库进行了系统的文献检索，检索时间截至 2015 年 12 月。纳入了研究房颤患者缺血性脑卒中的成本和/或资源利用的研究。报告的成本转换为国际元（I$），并调整为 2015 年的数值。在对纳入研究进行叙述性综述的同时，还使用 Spearman 相关系数、独立样本 t 检验和单因素方差分析来探讨与研究之间成本差异相关的因素。确定了来自 9 个国家的 16 项研究。基于 2015 年的货币转换率，缺血性脑卒中相关医疗费用估计分别为高收入、中上收入和中下收入经济体的 I$41420、I$12895 和 I$8184。各国之间医疗费用变化的 50%左右归因于本地人均 GDP。总体费用的主要组成部分来自住院治疗。年龄≥75 岁的 AF 患者发生缺血性脑卒中的费用是年龄较轻患者的 2.3 倍（P=0.049）。房颤患者发生缺血性脑卒中的经济负担相当大，与国家收入呈正相关。临床医生和利益相关者应该意识到抗凝治疗对卒中预防、卒中发生和老龄化人口增加带来的经济负担的重要性。
