Article Text

Download PDFPDF

Original research
A two-part model to estimate inpatient, outpatient, prescribing and care home costs associated with atrial fibrillation in Scotland
  1. Giorgio Ciminata1,
  2. Claudia Geue1,
  3. Peter Langhorne2,
  4. Olivia Wu1
  1. 1 Health Economics and Health Technology Assessment (HEHTA), University of Glasgow, Glasgow, UK
  2. 2 Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  1. Correspondence to Mr Giorgio Ciminata; g.ciminata.1{at}


Objective This study aimed to estimate global inpatient, outpatient, prescribing and care home costs for patients with atrial fibrillation using population-based, individual-level linked data.

Design A two-part model was employed to estimate the probability of resource utilisation and costs conditional on positive utilisation using individual-level linked data.

Settings Scotland, 5 years following first hospitalisation for AF between 1997 and 2015.

Participants Patients hospitalised with a known diagnosis of AF or atrial flutter.

Primary and secondary outcome measures Inpatient, outpatient, prescribing and care home costs.

Results The mean annual cost for a patient with AF was estimated at £3785 (95% CI £3767 to £3804). Inpatient admissions and outpatient visits accounted for 79% and 8% of total costs, respectively; prescriptions and care home stay accounted for 7% and 6% of total costs. Inpatient cost was the main driver across all age groups. While inpatient cost contributions (~80%) were constant between 0 and 84 years, they decreased for patients over 85 years. This is offset by increasing care home cost contributions. Mean annual costs associated with AF increased significantly with increasing number of comorbidities.

Conclusion This study used a contemporary and representative cohort, and a comprehensive approach to estimate global costs associated with AF, taking into account resource utilisation beyond hospital care. While overall costs, considerably affected by comorbidity, did not increase with increasing age, care home costs increased proportionally with age. Inpatient admission was the main contributor to the overall financial burden of AF, highlighting the need for improved mechanisms of early diagnosis to prevent hospitalisations.

  • health economics
  • atrial fibrillation
  • stroke
  • cost analysis

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

View Full Text

Statistics from


  • Contributors GC, CG, PL and OW conceived the article. GC carried out the statistical analysis and prepared the first draft of the manuscript. GC, CG, PL and OW contributed to editing the manuscript and approved the final version submitted for publication.

  • Funding This work was supported by Farr Institute for Health Informatics Research, Scotland, MRC, grant number MR/K007017/1.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval No ethics approval was sought as this study does not require consenting/contacting patients directly. All data used by researchers are pseudonymised, data reported are aggregated to minimise risk of identification and output clearance is required.

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

  • Data availability statement Data may be obtained from a third party and are not publicly available. All data underlying the analyses are confidential and subject to disclosure control. Data can only be obtained through application to Information Services Division (ISD) via the Public Benefit and Privacy Panel (PBPP).

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.