Healthcare resource utilisation and costs associated with a heart failure diagnosis: a retrospective, population-based cohort study in Sweden

Abstract

ObjectivesTo examine healthcare resource use (HRU) and costs among heart failure (HF) patients using population data from Sweden.DesignRetrospective, non-interventional cohort study.SettingTwo cohorts were identified from linked national health registers (cohort 1, 2005–2014) and electronic medical records (cohort 2, 2010–2012; primary/secondary care patients from Uppsala and Västerbotten).ParticipantsPatients (aged ≥18 years) with primary or secondary diagnoses of HF (≥2 International Classification of Diseases and Related Health Problems, 10th revision classification) during the identification period of January 2005 to March 2015 were included.Outcome measuresHRU across the HF phenotypes was assessed with logistic regression. Costs were estimated based on diagnosis-related group codes and general price lists.ResultsTotal annual costs of secondary care of prevalent HF increased from SEK 6.23 (€0.60) to 8.86 (€0.85) billion between 2005 and 2014. Of 4648 incident patients, HF phenotype was known for 1715: reduced ejection fraction (HFrEF): 64.5%, preserved ejection fraction (HFpEF): 35.5%. Within 1 year of HF diagnosis, the proportion of patients hospitalised was only marginally higher for HFrEF versus HFpEF (all-cause (95% CI): 64.7% (60.8 to 68.4) vs 63.7% (60.8 to 66.5), HR 0.91, p=0.14; cardiovascular disease related (95% CI): 61.1% (57.1 to 64.8) vs 60.9% (58.0 to 63.7), HR 0.93, p=0.28). Frequency of hospitalisations and outpatient visits per patient declined after the first year. All-cause secondary care costs in the first year were SEK 122 758 (€12 890)/patient/year, with HF-specific care accounting for 69% of the costs. Overall, 10% of the most expensive population (younger; predominantly male; more likely to have comorbidities) incurred ~40% of total secondary care costs.ConclusionsHF-associated costs and HRU are high, especially during the first year of diagnosis. This is driven by high hospitalisations rates. Understanding the profile of resource-intensive patients being at younger age, male sex and high Charlson comorbidity index scores at the time of the HF diagnosis is most likely a sign of more severe disease.

Persistent High Burden of Heart Failure Across the Ejection Fraction Spectrum in a Nationwide Setting

“… 16 Similar findings have been reported in Sweden. 17 Consistently with the higher comorbidity burden in HF versus non‐HF, in our analysis we showed that patients with HF were also more likely treated with non‐HF drugs, which further contributes to increasing costs.…”

“… 18 In Sweden, the total amount of all‐cause secondary care costs in the first year after HF diagnosis was €12 890/patient/year. 17 The cardiovascular inpatient care accounted for the largest part of the total secondary care costs (€11 578/patient/year) and exhibited a strong decline after the first year from diagnosis. 17 However, this declining trend in costs is limited to the individual longitudinal trajectory.…”

“… 17 The cardiovascular inpatient care accounted for the largest part of the total secondary care costs (€11 578/patient/year) and exhibited a strong decline after the first year from diagnosis. 17 However, this declining trend in costs is limited to the individual longitudinal trajectory. At a population level, costs are still rising over time because of growing prevalence of HF, higher burden of comorbidities, longer survival linked with advances in medical care, and the consequent increasing number of repeated HF and non‐HF hospitalizations.…”

Impact analysis of heart failure across European countries: an ESC‐HFA position paper

“…Hospitalizations due to HF represent 1–2% of all admissions, 1 and therefore, costs of HF are mainly driven by hospitalization. 43 After the initial diagnosis, HF patients are hospitalized on average about once a year due to the HF worsening. 44 Of note, HF hospitalization is associated with high 30 day readmission rate, up to 25%.…”

Characteristics and management of very elderly patients with heart failure: a retrospective, population cohort study

“…3,8,26 Limitations of this study have been discussed in detail previously. 15,27 In short, the retrospective design of the present study is accompanied with challenges of identifying a cohort with a confirmed and validated diagnosis of HF, accounting for missing values for LVEF due to the absence of echo. Two diagnoses to define HF were expected to increase specificity, which might have excluded of more recent or milder cases of HF.…”