OBJECTIVES: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia affecting the growing elderly population. This study estimated the cost of symptomatic paroxysmal AF (PAF) and persistent AF (PsAF) to the national healthcare systems in Germany, Italy, and the UK in 2018, using a population-based approach

METHODS: The number of AF patients in Germany, Italy, and the UK were estimated using population projections from the US Census Bureau and AF/atrial flutter prevalence estimates from the 2016 Global Burden of Disease study. Symptomatic AF and AF type were determined based on the EORP-AF pilot registry. Per-patient or resource-utilization costs were applied, using published country-specific estimates. Five-year projections were based on population estimates. Costs were expressed as 2018 Euros.

RESULTS: For 2018, symptomatic PAF and PsAF is estimated to cost €3,200 million in Germany, €2,220 million in Italy, and €1,831 million in the UK. Costs were highest if patients were ≥65 years old, had PsAF, or were well-managed on antiarrhythmic drugs (AADs). The primary cost driver was hospitalizations in all countries. Subsequent cost drivers included prescriptions and patient support in Germany, interventions and prescriptions in Italy, and long-term care/nursing home and outpatient/emergency room visits in the UK. In patients not well-managed on AADs, the cost of PsAF was higher than that for PAF by €107 million in Germany, €74 million in Italy, and €70 million in the UK. By 2022, the cost of symptomatic PAF and PsAF was projected to increase to €3,375 million in Germany, €2,336 million in Italy, and €1960 million in the UK.

CONCLUSIONS: Symptomatic AF represents a substantial economic burden to national healthcare systems in Germany, Italy, and the UK. The economic burden of AF is expected to increase over the next 5 years. Reduction in hospitalizations and prescriptions may help reduce national healthcare costs related to AF.