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Healthcare delivery, economics and global health
Original research
Patient clusters and cost trajectories in the Swiss Atrial Fibrillation cohort
  1. Helena Aebersold1,
  2. Miquel Serra-Burriel1,
  3. Fabienne Foster-Wittassek1,
  4. Giorgio Moschovitis2,
  5. Stefanie Aeschbacher3,4,
  6. Angelo Auricchio5,
  7. Jürg Hans Beer6,7,
  8. Eva Blozik8,
  9. Leo H Bonati9,10,
  10. David Conen11,
  11. Stefan Felder12,
  12. Carola A Huber13,
  13. Michael Kuehne3,4,
  14. Andreas Mueller14,
  15. Jolanda Oberle15,16,
  16. Rebecca E Paladini3,4,
  17. Tobias Reichlin17,
  18. Nicolas Rodondi15,16,
  19. Anne Springer3,4,
  20. Annina Stauber14,
  21. Christian Sticherling3,4,
  22. Thomas D Szucs18,
  23. Stefan Osswald3,4,
  24. Matthias Schwenkglenks1,18
  1. 1 Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
  2. 2 Division of Cardiology, Ente Ospedaliero Cantonale (EOC), Opsedale Regionale di Lugano, Lugano, Switzerland
  3. 3 Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
  4. 4 Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
  5. 5 Department of Cardiology, Instituto Cardiocentro Ticino, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
  6. 6 Department of Medicine, Cantonal Hospital of Baden, Baden, Switzerland
  7. 7 Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
  8. 8 Institute of Primary Care, University of Zurich, Zurich, Switzerland
  9. 9 Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
  10. 10 Department of Neurology, University Hospital Basel, Basel, Switzerland
  11. 11 Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
  12. 12 Faculty of Business and Economics, University of Basel, Basel, Switzerland
  13. 13 Department of Health Sciences, Helsana Group, Zurich, Switzerland
  14. 14 Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland
  15. 15 Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
  16. 16 Department of General Internal Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
  17. 17 Department of Cardiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
  18. 18 Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
  1. Correspondence to Dr Helena Aebersold, Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich 8001, Switzerland; helena.aebersold{at}uzh.ch

Abstract

Objective Evidence on long-term costs of atrial fibrillation (AF) and associated factors is scarce. As part of the Swiss-AF prospective cohort study, we aimed to characterise AF costs and their development over time, and to assess specific patient clusters and their cost trajectories.

Methods Swiss-AF enrolled 2415 patients with variable duration of AF between 2014 and 2017. Patient clusters were identified using hierarchical cluster analysis of baseline characteristics. Ongoing yearly follow-ups include health insurance clinical and claims data. An algorithm was developed to adjudicate costs to AF and related complications.

Results A subpopulation of 1024 Swiss-AF patients with available claims data was followed up for a median (IQR) of 3.24 (1.09) years. Average yearly AF-adjudicated costs amounted to SFr5679 (€5163), remaining stable across the observation period. AF-adjudicated costs consisted mainly of inpatient and outpatient AF treatment costs (SFr4078; €3707), followed by costs of bleeding (SFr696; €633) and heart failure (SFr494; €449). Hierarchical analysis identified three patient clusters: cardiovascular (CV; N=253 with claims), isolated-symptomatic (IS; N=586) and severely morbid without cardiovascular disease (SM; N=185). The CV cluster and SM cluster depicted similarly high costs across all cost outcomes; IS patients accrued the lowest costs.

Conclusion Our results highlight three well-defined patient clusters with specific costs that could be used for stratification in both clinical and economic studies. Patient characteristics associated with adjudicated costs as well as cost trajectories may enable an early understanding of the magnitude of upcoming AF-related healthcare costs.

  • Atrial Fibrillation
  • Health Care Economics and Organizations

Data availability statement

Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. The Swiss-AF Study protocol was approved by the local ethics committee (Ethikkommission Nordwest- und Zentralschweiz), and written informed consent was obtained from each participant. The patient informed consent forms state that the data, containing personal and medical information, are exclusively available for research institutions in an anonymised form and are not allowed to be made publicly available. Researchers interested in obtaining the data for research purposes can contact the Swiss-AF scientific lead. Contact information is provided on the Swiss-AF website (http://www.swissaf.ch/contact.htm). Authorisation of the responsible ethics committee is mandatory before the requested data can be transferred to external research institutions.

https://doi.org/10.1136/heartjnl-2022-321520

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    Data availability statement

    Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. The Swiss-AF Study protocol was approved by the local ethics committee (Ethikkommission Nordwest- und Zentralschweiz), and written informed consent was obtained from each participant. The patient informed consent forms state that the data, containing personal and medical information, are exclusively available for research institutions in an anonymised form and are not allowed to be made publicly available. Researchers interested in obtaining the data for research purposes can contact the Swiss-AF scientific lead. Contact information is provided on the Swiss-AF website (http://www.swissaf.ch/contact.htm). Authorisation of the responsible ethics committee is mandatory before the requested data can be transferred to external research institutions.

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    Footnotes

    • Contributors All authors had a significant participation in the design of the study, in the analysis and interpretation of the results, or in the elaboration of the manuscript. HA acts as the guarantor and accepts full responsibility for the work, the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding This work is supported by grants of the Swiss National Science Foundation (grant numbers 105318_189195/1, 33CS30_148474, 33CS30_177520, 32473B_176178, and 32003B_197524), the Swiss Heart Foundation, the Foundation for Cardiovascular Research Basel (FCVR) and the University of Basel.

    • Competing interests AA is a consultant with Abbott, Boston Scientific, Backbeat, Cairdac, Corvia, EP Solutions, Medtronic, Microport CRM, Philips and XSpline; participates in clinical trials sponsored by Boston Scientific, Medtronic, Microport CRM, Philips and XSpline; and has intellectual properties assigned to Boston Scientific, Biosense Webster and Microport CRM. JHB reports grant support from the Swiss National Foundation of Science, the Swiss Heart Foundation and the Stiftung Kardio; grant support, speakers and consultation fees to the institution from Bayer, Sanofi and Daiichi Sankyo. DC received consulting fees from Roche Diagnostics, and speaker fees from Servier and BMS/Pfizer, all outside of the current work. MK reports personal fees from Bayer, personal fees from Böhringer Ingelheim, personal fees from Pfizer/BMS, personal fees from Daiichi Sankyo, personal fees from Medtronic, personal fees from Biotronik, personal fees from Boston Scientific, personal fees from Johnson&Johnson, personal fees from Roche, grants from Bayer, grants from Pfizer, grants from Boston Scientific, grants from BMS, grants from Biotronik and grants from Daiichi Sankyo. GM has received consultant fees for taking part in advisory boards from Novartis, Boehringer Ingelheim, Bayer, AstraZeneca and Daiichi Sankyo, all outside of the presented work. AM reports fellowship and training support from Biotronik, Boston Scientific, Medtronic, Abbott/St Jude Medical and Biosense Webster; speaker honoraria from Biosense Webster, Medtronic, Abbott/St Jude Medical, AstraZeneca, Daiichi Sankyo, Biotronik, MicroPort and Novartis; and consultant honoraria for Biosense Webster, Medtronic, Abbott/St Jude Medical and Biotronik. TR has received research grants from the Swiss National Science Foundation, the Swiss Heart Foundation and the sitem insel support fund, all for work outside the submitted study; speaker/consulting honoraria or travel support from Abbott/SJM, AstraZeneca, Brahms, Bayer, Biosense Webster, Biotronik, Boston Scientific, Daiichi Sankyo, Medtronic, Pfizer/BMS and Roche, all for work outside the submitted study; support for his institution’s fellowship programme from Abbott/SJM, Biosense Webster, Biotronik, Boston Scientific and Medtronic for work outside the submitted study. MS reports grants from the Swiss National Science Foundation, for the conduct of the study; grants from Amgen, grants from MSD, grants from Novartis, grants from Pfizer, grants from Roche, grants and personal fees from BMS and personal fees from Sandoz, all outside the submitted work. MS-B reports grants from the European Commission outside of the present work. CS has received speaker honoraria from Biosense Webster and Medtronic and research grants from Biosense Webster, Daiichi Sankyo and Medtronic. The remaining authors have nothing to disclose.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.