Delaney Joseph Ac, Yin Xiaoyan, Fontes João Daniel, Wallace Erin R, Skinner Asheley, Wang Na, Hammill Bradley G, Benjamin Emelia J, Curtis Lesley H, Heckbert Susan R
Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle, WA, USA.
Boston University School of Medicine, Boston, MA, USA.
SAGE Open Med. 2018 Feb 20;6:2050312118759444. doi: 10.1177/2050312118759444. eCollection 2018.
Atrial fibrillation is increasingly prevalent as the US population ages and is associated with significant morbidity and mortality. Care for patients with atrial fibrillation can be costly, US health care costs are comparatively high, and there are few cost estimates available that incorporate detailed measurement of comorbidities and their effects on costs.
In the Cardiovascular Health Study and the Framingham Heart Study, participants aged 65 years or older with newly diagnosed atrial fibrillation were matched on age and follow-up time to referents free of atrial fibrillation. The total clinical and hospital medical costs paid by Medicare Parts A and B (drug costs from Medicare Part D costs were not included) in the year prior to diagnosis (or matching) were compared with costs in the following year. Estimates were adjusted for other medical conditions and adjusted to 2009 dollars. In the Cardiovascular Health Study, 513 participants were diagnosed with new-onset atrial fibrillation and survived 30 days post-atrial fibrillation diagnosis, and 513 referents (as a control cohort) were identified, with a mean age of 77 years. In the Framingham Heart Study, we identified 336 participants diagnosed with atrial fibrillation, who survived 30 days post-atrial fibrillation diagnosis and matched these participants to 336 referents. We compared these new-onset atrial fibrillation participants with referents, using a difference in difference design to account for both time trends and differences between the two groups. The adjusted incremental cost for participants with atrial fibrillation, compared with referents, was US$18,060 (95% confidence interval: US$14,965-US$21,155) in the Cardiovascular Health Study and US$20,012 (95% confidence interval: US$15,057-US$24,966) in the Framingham Heart Study. The pooled estimate was US$18,601 (95% confidence interval: US$15,981-US$21,234).
Atrial fibrillation was associated with increased costs in the year after diagnosis in two community-based cohorts, even after careful accounting for age, time period, and systematically measured comorbidities.
随着美国人口老龄化，心房颤动日益普遍，且与显著的发病率和死亡率相关。对心房颤动患者的护理成本可能很高，美国医疗保健成本相对较高，而且很少有成本估算纳入对合并症及其对成本影响的详细衡量。
在心血管健康研究和弗雷明汉心脏研究中，将65岁及以上新诊断为心房颤动的参与者，按年龄和随访时间与无心房颤动的对照者进行匹配。将诊断（或匹配）前一年医疗保险A部分和B部分支付的总临床和医院医疗费用（不包括医疗保险D部分的药品费用）与次年的费用进行比较。对其他医疗状况进行了估算调整，并按2009年美元进行了调整。在心血管健康研究中，513名参与者被诊断为新发心房颤动，且在心房颤动诊断后存活30天，确定了513名对照者（作为对照队列），平均年龄为77岁。在弗雷明汉心脏研究中，我们确定了336名被诊断为心房颤动的参与者，他们在心房颤动诊断后存活30天，并将这些参与者与336名对照者进行匹配。我们使用差异中的差异设计，将这些新发心房颤动参与者与对照者进行比较，以考虑时间趋势和两组之间的差异。在心血管健康研究中，与对照者相比，心房颤动参与者的调整后增量成本为18,060美元（95%置信区间：14,965美元 - 21,155美元），在弗雷明汉心脏研究中为20,012美元（95%置信区间：15,057美元 - 24,966美元）。合并估计值为18,601美元（95%置信区间：15,981美元 - 21,234美元）。
在两个基于社区的队列中，即使在仔细考虑年龄、时间段和系统测量的合并症后，心房颤动在诊断后的一年中仍与成本增加相关。
