ABSTRACT
BACKGROUND: Over 454,000 hospitalizations have been associated with atrial fibrillation (AF) as a primary diagnosis . Guideline treatment of AF may improve outcomes and subsequently, reduce healthcare resource utilization (HCRU) and total cost of care (TCOC). Previous studies have assessed cost and HCRU in the Medicare population, but there is limited published data on the commercial population. OBJECTIVE(S): This study's primary objective was to measure TCOC in newly diagnosed non-valvular atrial fibrillation (NVAF) patients within a commercial health plan. METHOD(S): This retrospective case-control study used a commercial health plan claims database to identify members diagnosed with incident NVAF between January 1, 2018, and December 31, 2018 (first diagnosis was index) with 12-month continuous enrollment pre- and post-index and baseline CHA2DS2-VASc >= 2 (N = 1,717). This study period was chosen to capture pre-COVID-19 data. Members with >= 1 claim for an oral anticoagulant (OAC) on or after the index date (treated cohort) were compared to an untreated cohort. Inverse probability of treatment weighting was used to adjust for differences in baseline characteristics. Costs were assessed for medical and pharmacy utilization over a 12-month period. RESULT(S): Compared to the untreated cohort (n = 860), the treated cohort (n = 857, 49.9%) had higher mean - inpatient (IP) costs ($34,023 vs $25,135), emergency room costs ($3,861 vs $2,375), pharmacy costs ($9,054 vs $5,222) and TCOC costs ($69,489 vs $43,950). A higher IP diagnosis of NVAF was observed in the treated cohort compared to the untreated cohort (18.2% vs 3.6%). Rates of stroke were higher in the treated cohort compared to the untreated cohort (3.27% vs 0.14%). Among those receiving an OAC (treated cohort), 67.7% had a treatment duration of <=180 days during the 12-month follow-up period. CONCLUSION(S): Using nationwide commercial claims data, the study showed TCOC was higher for those treated with OAC compared to patients not treated with OAC which prompted additional analyses to better explain the findings. Although recognized AF management guidelines are available, recommended treatment with OAC in patients at high risk for stroke remains suboptimal (50%) with limited duration of therapy. Key study limitations include small sample size and potential channeling bias. The results provide previously unreported data for a younger population with commercial insurance and contribute to a growing body of data showing a gap in care in patients with NVAF. Study outcomes highlight an opportunity for improved care management and better communication with providers and patients along the care pathway.