Medical Costs and Productivity Losses of Atrial Fibrillation Among US Privately Insured Employees

TL;DR

Atrial fibrillation increases medical costs and productivity losses for working-age insured employees in the US.

Contribution

Quantifies economic burden of atrial fibrillation in working-age adults with private insurance, including productivity losses.

Findings

AF was associated with $11,392.55 higher annual medical costs, mostly from outpatient care.

Productivity losses totaled $840.32 per person due to sick leave and short-term disability.

Females had higher emergency and inpatient care costs related to AF compared to males.

Abstract

This cross-sectional study estimates medical costs and productivity losses associated with atrial fibrillation (AF) among privately insured employees in the US.

What are the medical costs and productivity losses associated with atrial fibrillation (AF) among privately insured US employees?

In this cross-sectional study of 1 612 398 US adults aged 18 to 64 years with employer-sponsored insurance, persons with AF incurred $11 392.55 more in excess annual medical costs—primarily from outpatient care ($7058.81 for services and $1874.58 for prescriptions)—and $840.32 more in excess productivity-related costs from sick leave and short-term disability than those without AF.

This study found that AF was associated with a substantial economic burden among working-age adults through increased outpatient care costs and workplace productivity losses, suggesting opportunities for targeted interventions in outpatient treatment and workplace support.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major factor underlying US health care costs. While its clinical burden is well documented, the full economic impact of AF—particularly among working-age adults with productivity losses—remains underexplored.

To estimate medical costs and productivity losses associated with AF among privately insured US employees and assess whether this burden varies by sex and rurality.

This cross-sectional study used 2021 Merative MarketScan Commercial Claims and Health and Productivity Management Databases. The sample included adults aged 18 to 64 years with continuous enrollment in noncapitated, employer-sponsored insurance and no pregnancy-related diagnoses. Analyses were conducted during January to July 2025.

Diagnosis of AF, defined by 1 or more inpatient or emergency department claims or 2 or more outpatient claims with International Classification of Disease, Tenth Revision, Clinical Modification code I48.

Primary outcomes were total all-cause annual medical costs and productivity losses. Medical costs were disaggregated into emergency department, inpatient, outpatient, and prescription costs. Productivity losses included sick leave, short-term disability, and long-term disability; days were observed directly, and dollar-valued costs were estimated by applying national average wages. All outcomes were prespecified. Propensity score overlap weighting was applied to balance covariates.

Among 1 612 398 individuals (mean [SD] age, 44.00 [11.11] years; 623 335 female [38.66%]; 1 489 709 [92.39%] living in an urban area), 10 190 (0.63%) were diagnosed with AF. AF was associated with $11 392.55 (95% CI, $10 649.70-$12 135.38) in incremental annual medical costs, primarily from outpatient care ($7058.81 [95% CI, $6563.89-$7553.72] for services and $1874.58 [95% CI, $1600.61-$2148.56] for prescriptions). Compared with those without AF, those with AF had 0.97 (95% CI, 0.02-1.93) excess sick leave days and 2.93 (95% CI, 2.14-3.72) excess short-term disability days, translating to productivity-related costs of $269.81 (95% CI, $144.65-$397.77) for sick leave and $570.51 (95% CI, $471.21-$669.81) for short-term disability. Long-term disability outcomes did not differ significantly. Females incurred higher AF-related emergency (mean difference, $422.61; 95% CI, $178.32-$666.89) and inpatient care costs (mean difference, $1588.67; 95% CI, $466.23-$2711.12) than males.

In this cross-sectional study of privately insured employees, AF was associated with $11 393 in higher medical costs per person, with outpatient care accounting for the largest share, and $840 in higher productivity losses per person. These findings underscore the need to improve outpatient treatment and reduce AF-related workplace disruptions for working-age adults.

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