Abstract
Introduction: Sex-related differences in health care utilization have been described for patients (pts) with any atrial fibrillation (AF) either with or without atrial flutter (AFL). Limited data, however, are available when stratified by sex in pts with AFL only. Methods: Using MarketScan Commercial and Medicare databases, pts aged 20 years with a minimum of one inpatient or two outpatient AFL diagnoses in 2005 and a minimum of 12 months of continuous enrollment pre and post index were identified. Any AF pts were excluded. AFL only pts were propensity score matched to pts without AFL or AF based on age, sex, region, payer, and cardiovascular (CV) comorbidities. Using projected prevalence of AFL for 2010, costs were estimated 12 months post index. Results: 1,042 pts (62 % men) with AFL were identified. Men exceeded women in the age adjusted prevalence of AFL across all age groups (mean age 67 with 8 age ranges from 20 to 85). Cost projections were made for 74,466 AFL pts. Men ($453 million) had a significantly higher national total incremental cost burden for all expenditures than women ($253 million). Men had higher per patient incremental cost and national cost burden for treatment specific to AFL across the age groups. Men also had a higher per patient incremental cost and national total cost burden ($291 versus $90 million) for CV specific expenditures, especially at ages < 85. Total costs were greatest for men < 55 years old with total costs of 25,643 dollars per patient of which 75 % of the value represented CV specific costs. Per patient costs were more similar for men and women with AFL at 55 years and older. Per patient inpatient costs were greater in men whereas per patient outpatient costs were greater in women. On a national and per patient cost level, AFL treatment specific costs decreased in men and women 75 years and older. Conclusions: Costs in pts with AFL only are more driven by men from both a per patient and national cost perspective with the highest burden at younger ages < 55. These sex-related differences in epidemiology and resource utilization need further exploration. Potential disparities in care delivery may exist given these cost data.