Healthcare Costs Among Patients with Heart Failure: A Comparison of Costs between Matched Decedent and Survivor Cohorts

Engels, N; Swindle, Jason; Turner, Stuart; Russo, Patrícia A.; Altan, Aylin

doi:10.1007/s12325-016-0454-y

Cited by 10 publications

(23 citation statements)

References 19 publications

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“…In 40 (45%) studies [ 22 – 24 , 44 , 46 , 47 , 49 , 50 , 53 , 55 , 57 , 58 , 60 – 86 ], costs for HF-related events were (or appeared to have been) analyzed from a payer’s perspective. Three studies adopted a healthcare sector perspective [ 87 – 89 ]. Only two studies adopted the societal perspective [ 25 , 59 ], one study adopted the viewpoint of the patient [ 43 ], and one the hospital perspective [ 45 ].…”

Section: Resultsmentioning

confidence: 99%

“…The study by Obi et al [ 87 ] compared annual total medical costs between patients with HF who died to those who survived (stratified by health plan type). Authors found that patients who died incurred substantially higher costs from index to death, as compared with survivors, despite the mean post-index period being 59% shorter compared with survivors (matched cohorts).…”

Section: Resultsmentioning

confidence: 99%

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A Systematic Review of Medical Costs Associated with Heart Failure in the USA (2014–2020)

et al. 2020

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Background Heart failure presents a growing clinical and economic burden in the USA. Robust cost data on the burden of illness are critical to inform economic evaluations of new therapeutic interventions. Objectives This systematic literature review of heart failure-related costs in the USA aimed to assess the quality of the published evidence and provide a narrative synthesis of current data. Methods Four electronic databases (MEDLINE, EMBASE, EconLit, and the Centre for Reviews and Dissemination York Database, including the NHS Economic Evaluation Database and Health Technology Assessment Database) were searched for journal articles published between January 2014 and March 2020. The review, registered with PROSPERO (CRD42019134201), was restricted to cost-of-illness studies in adults with heart failure events in the USA. Results Eighty-seven studies were included, 41 of which allowed a comparison of cost estimates across studies. The annual median total medical costs for heart failure care were estimated at $24,383 per patient, with heart failure-specific hospitalizations driving costs (median $15,879 per patient). Analyses of subgroups revealed that heart failure-related costs are highly sensitive to individual patient characteristics (such as the presence of comorbidities and age) with large variations even within a subgroup. Additionally, differences in study design and a lack of standardized reporting limited the ability to compare cost estimates. The finding that costs are higher for patients with heart failure with reduced ejection fraction compared with patients with preserved ejection fraction highlights the need for differentiating among different heart failure types. Conclusions The review underpins the conclusion drawn in earlier reviews, namely that hospitalization costs are the key driver of heart failure-related costs. Analyses of subgroups provide a clearer understanding of sources of heterogeneity in cost data. While current cost estimates provide useful indications of economic burden, understanding the nuances of the data is critical to support its application. Electronic supplementary material The online version of this article (10.1007/s40273-020-00952-0) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Medical Costs Associated with Heart Failure in the USA (2014–2020)

et al. 2020

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“…This study required that patients had 12 months of continuous enrollment after the HFrEF index date, which meant that all included patients had survived through at least the 12-month worsening assessment period. This design contrasts with other studies that included patients who died during the period immediately following diagnosis because of the availability of mortality data, and who therefore would have incurred higher costs [ 32 , 33 ]. A retrospective claims study from a large US health plan (commercial and Medicare Advantage with Part D) showed that costs within 1 year after an HF-related encounter were markedly higher for patients who died versus those who survived during that period.…”

Section: Discussionmentioning

confidence: 99%

“…A retrospective claims study from a large US health plan (commercial and Medicare Advantage with Part D) showed that costs within 1 year after an HF-related encounter were markedly higher for patients who died versus those who survived during that period. The cost difference occurred despite the truncated post-index period for those who died, and the largest cost driver was hospitalizations [ 33 ]. Given that mortality is associated with increased cost, the present study likely underestimates costs during the worsening assessment period by including only patients with 12 months continuous enrollment after HFrEF diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Economic Burden of Chronic Heart Failure and Reduced Ejection Fraction Following a Worsening Heart Failure Event

et al. 2020

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Introduction A worsening heart failure event (WHFE) is defined as progressively escalating heart failure signs/symptoms requiring intravenous diuretic treatment or hospitalization. No studies have compared the burden of chronic heart failure with reduced ejection fraction (HFrEF) following a WHFE versus stable disease to inform healthcare decision makers. Methods A retrospective study using the IBM ® MarketScan ® Commercial Database included patients younger than 65 years of age with HFrEF (one inpatient or two outpatient claims of systolic HF or one outpatient claim of systolic HF plus one outpatient claim of any HF). The first claim for HFrEF during 2016 was the index date. Patients were followed for the first 12 months after the index date (the worsening assessment period) to identify a WHFE, and for an additional 12 months or until the end of continuous enrollment (the post-worsening assessment period). Mean per patient per month (PPPM) health care resource use (HCRU) and costs were compared between patients following a WHFE and stable patients during the two periods using generalized linear models adjusting for patient characteristics. Results Of 16,646 patients with chronic HFrEF, 26.8% developed a WHFE. Adjusted all-cause hospitalizations (0.16 vs. 0.02 PPPM, P < 0.0001), outpatient visits (3.54 vs. 2.73 PPPM, P < 0.0001), and emergency department visits (0.25 vs. 0.06 PPPM, P < 0.0001) were higher in patients following a WHFE than stable patients during the worsening assessment period. Similar differences in HCRU were observed between the two cohorts during the post-worsening assessment period. Mean total adjusted cost of care PPPM was $8657 in patients with HFrEF following a WHFE versus $2195 in stable patients during the worsening assessment period, and $6809 versus $2849, respectively, during the post-worsening assessment period. Conclusion HCRU and costs were significantly greater in patients with chronic HFrEF following a WHFE compared to those who remained stable, suggesting an unmet need to improve clinical and economic outcomes among these patients. Electronic supplementary material The online version of this article (10.1007/s12325-020-01456-1) contains supplementary material, which is available to authorized users.

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“…9 More recently, there has been a heightened awareness in frequent users of the ER for ADHF, because of both the system costs associated with frequent use of acute services and the associated mortality burden shortly after discharge. 10,11 Previous research has examined ways to risk stratify patients with HF presenting to the ER, particularly to understand the risk of repeat ER visits, hospitalization, or death. 12 One aspect of this patient population that has not been examined is the subset of patients with HF who present to the ER multiple times within a short time frame after discharge.…”

mentioning

confidence: 99%

Clustered Emergency Room Visits Following an Acute Heart Failure Admission: A Population‐Based Study

Posada

Moayedi

Zhou

et al. 2018

JAHA

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BackgroundWhile it is well known that heart failure patients presenting to the emergency room (ER) have high short‐term mortality after discharge, the outcomes of patients with heart failure with repeated ER visits within a short time are not known. In this study, we aimed to determine whether clustering is associated with an increased risk of death.Methods and ResultsThis is a retrospective, population‐based cohort study with an accrual window between 2003 and 2014 and maximal follow‐up up to and including March 31, 2015. Data were obtained from administrative databases from Ontario, Canada. Clustering was defined a priori as 3 or more ER visits within a 6‐month period. The main outcome of interest was time to death conditional on 6‐month survival. A total of 72 810 patients with an index hospitalization for acute heart failure were evaluated. ER clustering was observed in 15.1% of the population. Increased burden of comorbidities, primary rural residence, and lack of primary care provider were identified as factors associated with ER clustering. Age‐ and sex‐adjusted mortality for clustered patients was higher than for nonclustered (hazard ratio [HR] 1.51; 95% confidence interval, 1.47–1.55, P<0.0001). Adjusted mortality risk was also higher for patients with clustered ER visits (HR 1.42; 95% confidence interval 1.38–1.46; P<0.0001).ConclusionsClustering, as defined by 3 or more ER visits for any reason within 6 months of index heart failure hospitalization reflects a novel risk factor associated with increased mortality. Future research into the strategies to better manage complex patients with heart failure with recurrent ER visits are warranted.

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Healthcare Costs Among Patients with Heart Failure: A Comparison of Costs between Matched Decedent and Survivor Cohorts

Cited by 10 publications

References 19 publications

A Systematic Review of Medical Costs Associated with Heart Failure in the USA (2014–2020)

A Systematic Review of Medical Costs Associated with Heart Failure in the USA (2014–2020)

Clinical and Economic Burden of Chronic Heart Failure and Reduced Ejection Fraction Following a Worsening Heart Failure Event

Clustered Emergency Room Visits Following an Acute Heart Failure Admission: A Population‐Based Study

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