Inequalities in oral anticoagulant treatment patterns: a two-part model to estimate healthcare costs associated with atrial fibrillation

Abstract Background Atrial fibrillation (AF) is a common cardiac rhythm disorder associated with an increased risk of stroke, contributing to high healthcare costs. Oral anticoagulants (OACs) are well established in the management of AF, failure to initiate treatment and discontinuation or cessation remain a significant issue, especially among socioeconomically disadvantaged populations. The aim of this study is to quantify, in economic terms, the impact of different OAC treatment patterns in individuals living with AF and assess how socioeconomic factors affect healthcare costs. Methods This retrospective study analysed data from 47,427 individuals diagnosed with incident AF between 2010 and 2016 with CHA 2 DS 2 -VASC score of 2 or greater. The AF population was followed for five years, with Scottish data linked from inpatient, outpatient, prescribing, and care-home records. Four groups were defined based on OAC exposure: 1) never started OAC therapy, 2) continuous OAC therapy, 3) discontinuous OAC therapy, and 4) cessation of OAC therapy. We used Inverse Probability of Treatment Weights (IPTW) to estimate weights for our adjusted two-part econometric model, estimating inpatient, outpatient, prescribing, care-home and overall costs across the four OAC exposure groups. Results Continuous OAC therapy was associated with the lowest healthcare costs per patient per year (£7,288), mainly due to reduced hospitalizations and care-home admissions. Those who never started (£22,751), or ceased OAC therapy (£22,157), incurred the highest costs, driven by inpatient and long-term care needs. Healthcare costs increased with age, with the highest costs observed in the 76–85 years old and > 85 age groups, particularly for those who never started OAC therapy. Socio-economic deprivation was associated with greater healthcare costs (£20,562) while the least deprived groups incur the lowest (£12,734). Conclusions Continuous OAC therapy is associated with lower healthcare costs through fewer hospitalizations and reduced long-term care. Failure to initiate, discontinuation and cessation of OAC treatment are linked to higher costs, highlighting the relevance of sustained anticoagulation. Socioeconomic deprivation was associated with higher costs in disadvantaged groups. Improving treatment initiation and persistence, particularly in these populations, could reduce the economic burden of AF and improve patient outcomes.