OBJECTIVES: Atrial Fibrillation (AF) greatly increases the risk of stroke. AF-related stroke is associated with higher mortality, worse outcome and higher health care cost, which is substantial for patients and society. Few studies, however, of the costs of AF-related stroke were available in China. This study aimed to assess and compare the hospital costs and length-of-stay in patients with AF and AF-related stroke in China from payer’s perspective. METHODS:  Data were extracted from the Basic Medical Insurance Databases in 2010. 385 patients were randomly selected by stratified two-stage sampling. All information of patient demographic characters, clinical and costs were collected for the analysis. The descriptive statistics was used to describe patients’ demographic characters, the hospital stay and the hospital costs. Univariate and multivariable analyses were also used in the data analysis. RESULTS: Total 385 patients (mean age 70.6 years; 51.4% male) were evaluated, 59.0% of patients with AF and 41.0% of patients with AF-related stroke. The mean length-of-stay was 14.2 days (11.9 days AF and 17.5 days AF related stroke; P <0.001); the mean total cost was 17630.42(median:9323.25, IQR:5086.87-20193.43): 17734.93(median:6891.92, IQR:3898.78-20751.16) with AF and 17480.27(median:11975.32, IQR:7863.3-19941.85) with AF-related stroke( P <0.001). The multiple linear regressions showed that the hospital cost of AF-related stroke was 81% higher than the hospital cost of AF. Patients with basic medical insurance for urban employees had 39.6% higher costs than those with basic medical insurance for urban residents(P<0.001). Patients from tertiary hospitals had 97.8% higher costs than those from primary hospitals; (P <0.001) and patients from municipalities had 58.0% higher costs than those from prefecture-level cities; ( P <0.01). CONCLUSIONS: Patients with AF-related stroke is associated with significantly higher hospital costs compared with those with AF. It implied that stroke prevention in AF may have potential cost savings.