OBJECTIVES: Atrial fibrillation (AF), the most common cardiac arrhythmia, is strongly associated with increased risk of stroke and thromboembolism. AF prevalence increases with age. In many countries there is a growing awareness of the economic burden associated with AF in light of ageing populations and constrained public finances. This study searched to review recent estimates of the cost of illness associated with AF.
METHODS: A systematic review was performed of Medline, EMBASE, Cochrane Library, HS Economic Evaluation, HTA and DARE databases, and conference abstracts, from 1990 to date. Total costs, direct and indirect costs were extracted. Inclusion criteria were AF or atrial flutter patients. This included: persistent, permanent and paroxysmal AF. Exclusion criteria were acute onset AF and Post operative AF.
RESULTS: A total of 875 records were retrieved and 34 studies were included. The burden of AF is high and is increasing over time. Direct cost estimates ranged from $2,000 to $12,000 per patient per year in the USA, and from €400 to €3,000 in Western Europe. This is high or equivalent compared to estimates for other chronic conditions as diabetes (CAD$306; Canada 1999) and chronic angina (US$4949; USA 1999). The direct cost of managing AF represented 0.9%-2.4% of the national health care budget for the UK (2000) and had approximately doubled over the previous 5 years. Inpatient care and interventional procedures represented the largest cost component (where reported), accounting for 50% to 70% of total costs. In the USA, AF hospitalisations alone cost an estimated $6.65 billion per annum (2005). If indirect costs were included, cost estimates increased by up to 20% over direct costs alone.
CONCLUSIONS: The economic burden of AF is high in comparison to other chronic conditions, and is expected to increase over time due to population ageing; hospitalisations represent the main cost driver.
