Healthcare Expenditure on Atrial Fibrillation in the United States: The Medical Expenditure Panel Survey 2016-2021

ObjectivesTo provide a contemporary nationally representative assessment of atrial fibrillation (AF) and atrial flutter (AFL) expenditures in the United States. BackgroundAF prevalence is rising over time and management is evolving. However, there has been no contemporary national assessment of expenditures of AF. MethodsUsing Medical Expenditure Panel Survey (MEPS) 2016-2021 data, we identified individuals with AF or AFL using International Classification of Disease (ICD)-10 codes and reported total and categorized expenditures. Using two-part and gamma regression models, respectively, we estimated the incremental expenditures with AF for the entire population and for individuals with common coexisting comorbidities. Among individuals with AF, we identified characteristics associated with higher expenditures. ResultsOf a weighted surveyed population of 248,067,064 adults, 3,564,763 (1.4%) had AF. Mean age was 71.9 {+/-} 10.6 years and 45.7% were female. Mean unadjusted annual total healthcare expenditure for individuals with AF was $25,451 {+/-} $1,100 compared with $9,254 {+/-} $82 for individuals without AF. The highest spending categories were inpatient visits ($7,975 {+/-} $733) and prescriptions ($6,505 {+/-} $372). AF expenditures increased over the study period by 11.1%. After adjustment, the incremental annual expenditure attributable to AF was $6,188 per person. Incremental expenditures with AF were highest for those with cancer ($11,967, 95% CI $4,410 - $19,525), while AF did not significantly increase expenditures in HF (-$2,756, 95% CI -$10,048 - $4,535). Modified Charlson Comorbidity Index of 1 or [≥]2, uninsured status, cancer, poor income level, ASCVD, COPD, and later survey year were associated with higher expenditures. ConclusionAF is associated with substantial healthcare expenditures which are increasing over time. With changes in screening and management, expenditures need periodic reassessments. CONDENSED ABSTRACTO_ST_ABSIntroductionC_ST_ABSAF prevalence is rising, but contemporary national expenditure assessments are lacking. MethodsTwo-part and gamma regression models of MEPS 2016-2021 data (all-payer cross-sectional US survey) estimated AF effect on healthcare expenditures. ResultsOf 248,067,064 adults, 1.4% had AF, with mean age 72.1 years and 45.7% female. Mean unadjusted annual expenditure was $25,451 {+/-} $1,100 ($9,254 {+/-} $82 without AF). Incremental adjusted annual expenditure attributable to AF was $6,188. Modified CCI of 1 or [≥]2, uninsured status, cancer, poor income level, ASCVD, COPD, and later survey year were associated with higher expenditure. DiscussionAF expenditures are substantial and increasing.