Jakobsen Marie, Kolodziejczyk Christophe, Klausen Fredslund Eskild, Poulsen Peter Bo, Dybro Lars, Paaske Johnsen Søren
KORA, Danish Institute for Local and Regional Government Research, Købmagergade 22, DK-1150, København K, Denmark.
Pfizer Denmark, Lautrupvang 8, DK-2750, Ballerup, Denmark.
BMC Health Serv Res. 2017 Jun 12;17(1):398. doi: 10.1186/s12913-017-2331-z.
Use of oral anticoagulation therapy in patients with atrial fibrillation (AF) involves a trade-off between a reduced risk of ischemic stroke and an increased risk of bleeding events. Different anticoagulation therapies have different safety profiles and data on the societal costs of both ischemic stroke and bleeding events are necessary for assessing the cost-effectiveness and budgetary impact of different treatment options. To our knowledge, no previous studies have estimated the societal costs of bleeding events in patients with AF. The objective of this study was to estimate the 3-years societal costs of first-incident intracranial, gastrointestinal and other major bleeding events in Danish patients with AF.
The study was an incidence-based cost-of-illness study carried out from a societal perspective and based on data from national Danish registries covering the period 2002-2012. Costs were estimated using a propensity score matching and multivariable regression analysis (first difference OLS) in a cohort design.
Average 3-years societal costs attributable to intracranial, gastrointestinal and other major bleeding events were 27,627, 17,868, and 12,384 EUR per patient, respectively (2015 prices). Existing evidence shows that the corresponding costs of ischemic stroke were 24,084 EUR per patient (2012 prices). The average costs of bleeding events did not differ between patients with AF who were on oral anticoagulation therapy prior to the event and patients who were not.
The societal costs attributable to major bleeding events in patients with AF are significant. Intracranial haemorrhages are most costly to society with average costs of similar magnitude as the costs of ischemic stroke. The average costs of gastrointestinal and other major bleeding events are lower than the costs of intracranial haemorrhages, but still substantial. Knowledge about the relative size of the costs of bleeding events compared to ischemic stroke in patients with AF constitutes valuable evidence for decisions-makers in Denmark as well as in other countries.
心房颤动（AF）患者使用口服抗凝治疗涉及降低缺血性卒中风险与增加出血事件风险之间的权衡。不同的抗凝治疗具有不同的安全性，缺血性卒中和出血事件的社会成本数据对于评估不同治疗方案的成本效益和预算影响至关重要。据我们所知，此前尚无研究估算AF患者出血事件的社会成本。本研究的目的是估算丹麦AF患者首次发生颅内、胃肠道及其他重大出血事件的3年社会成本。
本研究是一项基于发病率的疾病成本研究，从社会角度开展，基于丹麦国家登记处2002年至2012年期间的数据。在队列设计中，使用倾向评分匹配和多变量回归分析（一阶差分OLS）估算成本。
每位患者颅内、胃肠道及其他重大出血事件的平均3年社会成本分别为27,627欧元、17,868欧元和12,384欧元（2015年价格）。现有证据表明，缺血性卒中的相应成本为每位患者24,084欧元（2012年价格）。出血事件发生前接受口服抗凝治疗的AF患者与未接受治疗的患者之间，出血事件的平均成本无差异。
AF患者重大出血事件的社会成本很高。颅内出血对社会造成的成本最高，平均成本与缺血性卒中的成本相当。胃肠道及其他重大出血事件的平均成本低于颅内出血，但仍然很高。了解AF患者出血事件成本与缺血性卒中成本的相对规模，为丹麦及其他国家的决策者提供了有价值的证据。
