BACKGROUND: Directly acting oral anticoagulants (DOACs) have been shown to reduce the incidence and morbidity of stroke in non-valvular atrial fibrillation patients. Acute event and long-term management costs of ischaemic stroke (IS) and intracranial haemorrhage (ICH) are important inputs when evaluating the cost-effectiveness estimates of the DOACs. However, many cost-effectiveness models apply outdated costs published before the licensing of DOACs in the UK (2013).

OBJECTIVES: To systematically identify the costs of managing IS and ICH in patients with atrial fibrillation (AF) that reflect current clinical practice within the UK.

METHODS: A targeted literature review was conducted to identify UK costs for acute and post-event IS and ICH. Searches were conducted in standard, recommended search engines and databases.

RESULTS: 55 relevant studies were identified. Only 4 de novo cost or HRU studies were found in the AF/NVAF population, with only 2 out of 4 studies reporting post-acute management costs. 7 de novo cost studies were identified in non-AF/NVAF populations. The bulk of the de novo cost studies were published before 2013 (n=7), before the licensing of DOACs in the UK. Acute event costs were typically not disaggregated from management costs. Acute event costs reported in the literature were typically higher than the NHS reference costs for stroke events, which are the gold-standard in cost-effectiveness modelling. This is most likely due to the exclusion of ICU and rehabilitation costs for stroke/ICH for ordinary non-elective short stays and long stays.

CONCLUSIONS: The evidence base for costs of IS and ICH management in UK patients with NVAF is limited. A challenge for economic models is to ensure that the source of event costs remains clinically relevant. Further research is warranted in this area.