Cost of care distribution in atrial fibrillation patients: The COCAF study

被引:207
作者
Le Heuzey, JY [1 ]
Paziaud, O
Piot, O
Said, MA
Copie, X
Lavergne, T
Guize, L
机构
[1] Hop Europeen Georges Pompidou, Dept Cardiol, 20 Rue Leblanc, F-75015 Paris, France
[2] Ctr Cardiol Nord, St Denis Messageries, Reunion, France
关键词
D O I
10.1016/S0002-8703(03)00524-6
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Atrial fibrillation (AF) currently represents a major economic burden for society. Very few studies have been performed to evaluate the cost of care for AF patients. This study is a large prospective survey designed to analyze the different cost drivers in the treatment of these patients. This survey, named Cost of Care in Atrial Fibrillation (COCAF), evaluated the cost of care for patients with AF treated by cardiologists in general office practice. Methods A group of 671 patients was recruited by 82 cardiologists distributed in all regions of France. The mean age of the patients was 69 years, and 64% were male. The mean follow-up was 329 +/- 120 days. The costs of care were analyzed from the health care payer and the societal perspectives. Results During the follow-up peri ad, 21 patients (3.13%) died and 210 (31.3%) patients were hospitalized. The number of hospitalizations and deaths was significantly higher in the group of persistent or permanent AF (PEAF) patients, as compared to paroxysmal AF (PAAF) patients. Hospitalizations were much more frequent in the PEAF group (127) than in the PAAF group (83, P <.05). Deaths were also much more frequent in the PEAF group (17) as compared to the PAAF group (4, P <.001). From the societal perspective, the first cost driver was hospitalizations (52%), followed by drugs (23%), consultations (9%), further investigations (8%), loss of work (6%), and paramedical procedures (2%). In multivariate analysis the following parameters were significantly associated with higher costs: heart failure(P <.04), coronary artery disease (P <.001), use of class III antiarrhythmic drugs (P <.002), hypertension (P <.002) and metabolic disease (P <.001). Conclusions This prospective survey shows that hospitalizations represent the major cost driver in the treatment of AF patients. Outpatient care programs must be proposed to AF patients in order to avoid readmissions and to reduce the cost of treatment.
引用
收藏
页码:121 / 126
页数:6
相关论文
共 23 条
[1]   Impact of atrial fibrillation on the risk of death [J].
Benjamin, EJ ;
Wolf, PA ;
D'Agostino, RB ;
Silbershatz, H ;
Kannel, WB ;
Levy, D .
CIRCULATION, 1998, 98 (10) :946-952
[2]   Cost-effectiveness of cardioversion and antiarrhythmic therapy in nonvalvular atrial fibrillation [J].
Catherwood, E ;
Fitzpatrick, WD ;
Greenberg, ML ;
Holzberger, PT ;
Malenka, DJ ;
Gerling, BR ;
Birkmeyer, JD .
ANNALS OF INTERNAL MEDICINE, 1999, 130 (08) :625-+
[3]  
*CNAMTS, 1995, 81 CNAMTS
[4]   Acute treatment of atrial fibrillation: Spontaneous conversion rates and cost of care [J].
Dell'Orfano, JT ;
Patel, H ;
Wolbrette, DL ;
Luck, JC ;
Naccarelli, GV .
AMERICAN JOURNAL OF CARDIOLOGY, 1999, 83 (05) :788-790
[5]   Cost-effectiveness of stroke prevention [J].
Ebrahim, S .
BRITISH MEDICAL BULLETIN, 2000, 56 (02) :557-570
[6]   Cost-effectiveness of therapies for patients with nonvalvular atrial fibrillation [J].
Eckman, MH ;
Falk, RH ;
Pauker, SG .
ARCHIVES OF INTERNAL MEDICINE, 1998, 158 (15) :1669-1677
[7]   Decrease in mortality in patients with a hospital diagnosis of atrial fibrillation in Denmark during the period 1980-1993 [J].
Frost, L ;
Engholm, G ;
Moller, H ;
Husted, S .
EUROPEAN HEART JOURNAL, 1999, 20 (21) :1592-1599
[8]   ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation -: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology [J].
Fuster, V ;
Rydén, LE ;
Asinger, RW ;
Cannom, DS ;
Crijns, HJ ;
Frye, RL ;
Halperin, JL ;
Kay, GN ;
Klein, WW ;
Lévy, S ;
McNamara, RL ;
Prystowsky, EN ;
Wann, LS ;
Wyse, DG .
EUROPEAN HEART JOURNAL, 2001, 22 (20) :1852-1923
[9]   COST-EFFECTIVENESS OF WARFARIN AND ASPIRIN FOR PROPHYLAXIS OF STROKE IN PATIENTS WITH NONVALVULAR ATRIAL-FIBRILLATION [J].
GAGE, BF ;
CARDINALLI, AB ;
ALBERS, GW ;
OWENS, DK .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1995, 274 (23) :1839-1845
[10]   COST-EFFECTIVENESS OF PRIMARY STROKE PREVENTION IN ATRIAL-FIBRILLATION - SWEDISH NATIONAL PERSPECTIVE [J].
GUSTAFSSON, C ;
ASPLUND, K ;
BRITTON, M ;
NORRVING, B ;
OLSSON, B ;
MARKE, LA .
BRITISH MEDICAL JOURNAL, 1992, 305 (6867) :1457-1460