Health Care Resource Utilization and Costs in Individuals with Atrial Fibrillation in United Arab Emirates and Kingdom of Saudi Arabia: A Retrospective Cohort Study

Aims: Until recently, persons afflicted with atrial fibrillation (AF) were treated with warfarin to reduce the risk of stroke. Novel oral anticoagulants (NOACs) offer the possibility of less monitoring than warfarin. The objective of this study was to characterize resource utilization and corresponding costs incurred by individuals with AF in a real-world observational setting, in United Arab Emirates (UAE) and Kingdom of Saudi Arabia (KSA). Methods: A retrospective chart review was conducted at three hospitals in UAE and three in KSA to identify AF patients first diagnosed between January 2005 and June 2010. Patient charts were sampled consecutively backwards by diagnosis date, from June 2010 until the target sample size was reached. AF was identified based on ICD-9 code (427.31), from a sample of charts indicating a history of anticoagulant use. Data were collected on hospitalizations, outpatient and emergency room visits, medications, and monitoring and were abstracted from date of first diagnosis until June 2012. Those items were multiplied by country-specific unit costs taken from a public, third party payer perspective, and summed to derive the total annual costs per patient attributable to AF. Costs were converted to, and are reported in, $USD 2013. Results: Among 157 patients in UAE and 152 in KSA, the majority were diagnosed with chronic (persistent or permanent) AF (81% in UAE, 64% in KSA). The mean total annual costs per patient attributable to AF were $1,151 (standard deviation (SD): $1,796) per person in the UAE and $3,001 (SD: $3,502) per person in KSA, with monitoring costs being the largest contributor to costs in both countries (47% and 66%, respectively). In both countries, international normalized ration (INR) was a key contributor to monitoring test costs, and was performed less frequently in patients receiving a NOAC.