Abstract 275: Cost of Hospitalization for Heart Failure in the United States: A Systematic Literature Review

Abstract

Objectives: An estimated 6.5 million individuals were living with heart failure (HF) in the United States (US) between 2011 and 2014, with prevalence projected to increase 46% and direct medical costs to reach $53 billion by 2030. Hospitalizations are the largest component of direct medical costs for HF; however, recent publications synthesizing costs are lacking. The objective of this review was to synthesize contemporary estimates of cost per HF hospitalization (HFH) in the US. Methods: A systematic literature review was conducted using MEDLINE and EMBASE to identify articles reporting estimates of cost or charge per HFH in the US, published in English between 01/2014 and 5/2019. Double abstract and full-text review, and data extraction, were performed according to PRISMA guidelines. Subgroups of interest were those with both HF and renal disease or diabetes, as well as HF with reduced or preserved ejection fraction (HFrEF or HFpEF). All costs were converted to 2019 US dollars. Results: Of 2168 records identified, 207 full-text articles were screened, and 23 studies reporting cost (n=17 studies) or charge (n=4) per HFH were included; two studies reported both. Sample sizes ranged from 989 to approximately 11 million (weighted) HF patients. Mean age ranged from 65.0 to 83.3 years and percentage of males ranged from 38.7% to 74.0%. Median cost per HFH ranged from $7,094 to $9,769; mean cost ranged from $10,737 to $17,830 (see Figure). Charge per HFH ranged from $22,162 to $40,121 (median), and $50,569 to $50,952 (mean). Among patients with HF and chronic kidney disease, HFH mean cost ranged from $9,922 to $41,538. For those with HFrEF, mean cost ranged from $11,600 to $17,779 and $7,860 to $10,551 among those with HFpEF. No studies reported cost or charge per HFH for patients with both HF and diabetes. Cost and charge per HFH increased with length of stay (LOS), which ranged from 3.0 to 5.0 days (median) and 4.3 to 7.1 days (mean). Conclusions: This synthesis demonstrates the substantial economic burden of HFH, as well as variability in estimates of this burden. Factors contributing to variability in estimates include LOS, age and sex of the sample, HF severity, and percentage of patient with comorbidities. Further research into cost drivers of HF hospitalizations is warranted to understand potential ways to reduce associated costs.