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Implications of stroke and bleeding risk scores and comorbidities on episode-based bundled payments for patients with nonvalvular atrial fibrillation

Kaatz, Scott et al.

Current medical research and opinion. Volume 34:Number 2 (2018); pp 275-284 -- Informa Healthcare

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  • Title:
    Implications of stroke and bleeding risk scores and comorbidities on episode-based bundled payments for patients with nonvalvular atrial fibrillation
  • Author: Kaatz, Scott;
    Coleman, Craig I.;
    Bookhart, Brahim;
    Laliberté, François;
    Nelson, Winnie W.;
    Brown, Kip;
    Martin, Silas;
    Schein, Jeffrey;
    Lefebvre, Patrick
  • Found In: Current medical research and opinion. Volume 34:Number 2 (2018); pp 275-284
  • Journal Title: Current medical research and opinion
  • Subjects: Clinical medicine--Periodicals; Therapeutics--Periodicals; Nonvalvular atrial fibrillation--stroke--major bleeding--health costs--bundled payments; Dewey: 615.5
  • Rights: legaldeposit
  • Publication Details: Informa Healthcare
  • Abstract: Abstract:

    Objectives:Due to the high cost of nonvalvular atrial fibrillation (NVAF), this condition may be a suitable candidate for condition-specific bundled payments. This paper evaluates the healthcare cost of NVAF and uses common bleeding and stroke risk scores (HAS-BLED and CHA2DS2-VASc) to explore the risk-based healthcare cost differences among NVAF patients.

    Methods:MarketScan claims of NVAF patients (ICD-9-CM code 427.31) were analyzed from January 2010 to April 2015. These claims feature more than 196 million covered lives and more than 300 contributing employers and 25 contributing health plans. A retrospective cohort design was used to assess episodes of care costs among patients with NVAF. Previously and newly diagnosed NVAF patients were selected from adult patients with ≥2 diagnoses of NVAF, and without valvular disease. Total all-cause healthcare costs at 1 year were stratified by stroke (CHA2DS2-VASc) and bleeding (HAS-BLED) risk scores. Study data was extracted in the MarketScan Commercial Claims and Encounters Database (Commercial Database) and the MarketScan Medicare Supplemental and Coordination of Benefits Database (Medicare Supplemental Database).

    Results:Mean all-cause 1 year cost of care based on stroke risk (CHA2DS2-VASc) varied from $15, 703 to $59, 163 for previously diagnosed and $25, 992 to $62, 458 for newly diagnosed NVAF. Similarly, mean cost varied base on bleeding risk (HAS-BLED) for previously and newly diagnosed NVAF from $17, 950 to $57, 029 and $26, 356 to $67, 104 respectively.

    Conclusion:NVAF patients accrue variable healthcare costs. Stroke and bleeding risk should be taken into account during the creation of NVAF payment bundles.


  • Identifier: System Number: LDEAvdc_100055758233.0x000001; Journal ISSN: 0300-7995; 10.1080/03007995.2017.1409200
  • Publication Date: 2018
  • Physical Description: Electronic
  • Shelfmark(s): ELD Digital store

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