Economic Burden of Individual Suffering from Atrial Fibrillation-Related Stroke in China

Shanlian Hu; Lin Zhan; Bao Liu; Yue Gao; Yan Li; Rongsheng Tong; Lin Wu; Bo Yu; Shen Gao

doi:10.1016/j.vhri.2013.02.008

Economic Burden of Individual Suffering from Atrial Fibrillation-Related Stroke in China

Value Health Reg Issues. 2013 May;2(1):135-140. doi: 10.1016/j.vhri.2013.02.008. Epub 2013 Apr 30.

Authors

Shanlian Hu¹, Lin Zhan², Bao Liu³, Yue Gao⁴, Yan Li⁵, Rongsheng Tong⁶, Lin Wu⁷, Bo Yu⁸, Shen Gao⁹

Affiliations

¹ Shanghai Health Development Research Center, Shanghai, PR China; School of Public Health, Fudan University, Shanghai, PR China. Electronic address: hushanlian@hotmail.com.
² Boehringer Ingelheim, Shanghai, PR China.
³ School of Public Health, Fudan University, Shanghai, PR China.
⁴ School of Public Health, Fudan University, Shanghai, PR China; Shanghai Centennial Scientific Co. Ltd., Shanghai, PR China.
⁵ Department of Pharmacy, Xijing Hospital Affiliated to the Fourth Military Medical University, Xian, Shanxi Province, PR China.
⁶ Department of Pharmacy, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, PR China.
⁷ Department of Pharmacy, Guangzhou First Municipal People's Hospital, Guangzhou, Guangdong, PR China.
⁸ Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, PR China.
⁹ Department of Pharmacy, Chang Hai Hospital Affiliated to the Second Military Medical University, Shanghai, PR China.

PMID: 29702842
DOI: 10.1016/j.vhri.2013.02.008

Abstract

Objective: Atrial fibrillation (AF) is an important risk factor for stroke. The primary purpose of this study was to estimate the 1-year direct and indirect costs of ischemic stroke in Chinese patients with AF.

Method: A total of 300 charts were selected and reviewed in 18 hospitals from neurology departments in six major cities of China nationwide. Patients with primary diagnosis of ischemic stroke and secondary diagnosis of AF were selected for review. A total of 63 patients were selected from the chart review pool and followed up for 1 year to record their resource utilization and absenteeism from work following discharge.

Results: The mean±SD age of the cohort was 70.2±11.8 years, with an average hospitalization duration of stay of 17.9 days. The mean total direct cost for AF-related stroke was estimated at 30,438.3 China Yuan (CNY) per patient-year. The major cost driver for direct cost was stroke's acute hospitalization expense, which accounted for 61.5% (CNY 18,706.1). Among the seven patients not reaching the legal retirement age, the indirect cost per person-year totaled 16,838.9 CNY, most of which (63.0%) was a result of early retirement. The analysis also suggested that higher hospital ranking (based on the tier system), longer hospital stay, higher modified Rankin Scale score, taking surgery during hospitalization, receiving thrombolysis therapy, and incidence of complications such as pneumonia or cerebral edema predicted higher inpatient costs.

Conclusions: Hospital costs due to strokes among patients with AF are the predominant contributor to the total direct cost, which is consistent with current hospital-centered treatment pattern in China. However, literature suggested that AF-induced strokes are highly preventable with drugs and clinical procedures, which highlights the importance of optimal clinical management of stroke prevention in patients with AF.

Keywords: atrial fibrillation; cost of illness; ischemic stroke.