CARDIOVASCULAR MEDICINE

Cost of an emerging epidemic: an economic analysis of atrial fibrillation in the UK

S Stewart¹, N Murphy², A Walker³, A McGuire⁴, J J V McMurray²

¹ Division of Health Sciences, the University of South Australia, Adelaide, Australia
² Department of Cardiology, Western Infirmary, Glasgow, UK
³ Robertson Centre for Biostatistics, the University of Glasgow, Glasgow, UK
⁴ Department of Health and Social Care, the London School of Economics, London, UK

Correspondence to:
Correspondence to:
Professor J McMurray
Department of Cardiology, Western Infirmary, Glasgow G11 6NT, UK; j.mcmurray{at}bio.gla.ac.uk

Objective: To evaluate the cost of atrial fibrillation (AF) to health and social services in the UK in 1995 and, based on epidemiological trends, to project this estimate to 2000.

Design, setting, and main outcome measures: Contemporary estimates of health care activity related to AF were applied to the whole population of the UK on an age and sex specific basis for the year 1995. The activities considered (and costs calculated) were hospital admissions, outpatient consultations, general practice consultations, and drug treatment (including the cost of monitoring anticoagulant treatment). By adjusting for the progressive aging of the British population and related increases in hospital admissions, the cost of AF was also projected to the year 2000.

Results: There were 534 000 people with AF in the UK during 1995. The "direct" cost of health care for these patients was £244 million (~350 million) or 0.62% of total National Health Service (NHS) expenditure. Hospitalisations and drug prescriptions accounted for 50% and 20% of this expenditure, respectively. Long term nursing home care after hospital admission cost an additional £46.4 million (~66 million). The direct cost of AF rose to £459 million (~655 million) in 2000, equivalent to 0.97% of total NHS expenditure based on 1995 figures. Nursing home costs rose to £111 million (~160 million).

Conclusions: AF is an extremely costly public health problem.

Keywords: atrial fibrillation; cost evaluation; morbidity; hospitalisation

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• Beery, T. T. (2005). The Genetics of Cardiac Arrhythmias. Biol Res Nurs 6: 249-261 [Abstract]  
• Fuller, R, Dudley, N J (2005). Atrial fibrillation: will new drugs and patient choice improve anticoagulation outcomes?. Heart 91: 423-424 [Abstract] [Full Text]  
• Jones, M, McEwan, P, Morgan, C L., Peters, J R, Goodfellow, J, Currie, C J (2005). Evaluation of the pattern of treatment, level of anticoagulation control, and outcome of treatment with warfarin in patients with non-valvar atrial fibrillation: a record linkage study in a large British population. Heart 91: 472-477 [Abstract] [Full Text]  
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• Steinberg, J S (2004). Atrial fibrillation: an emerging epidemic?. Heart 90: 239-240 [Full Text]