Abstract 305: Post-discharge Costs in Heart Failure: Kidney Disease Severity as a Key Contributor

Abstract

Background: This study examined post-discharge costs among individuals hospitalized with heart failure (HF) by stage of chronic kidney disease (CKD). Methods: A retrospective claims-based study of medical and pharmacy data linked to laboratory results from a large US health plan (Jan2007-Sep2012) was conducted. Earliest inpatient stay with HF diagnosis was defined as index hospitalization. Post-index costs were calculated per-member-per-month (PMPM) for the subset of individuals with a post-discharge observation up to 6 months. Individuals were assigned to CKD stages 1-5 using the CKD-Epidemiology Collaboration Group equation. One-way ANOVA was used to examine differences in follow-up health care costs across CKD stages. Results: A total of 24,023 individuals hospitalized with HF (mean age 70 y, 51% female, 71% white, 65% Medicare Advantage) were included. Subjects with at least moderately reduced renal function (eGFR <60 mL/min, stages 3-5) when compared to individuals with normal/mild reduction (eGFR ≥60 mL/min, stages 1-2) experienced higher follow-up ambulatory ($1,508 vs. $1,236) and inpatient ($3,725 vs. $3,152) all-cause costs. HF-related medical costs accounted for approximately 40% of all-cause medical cost for CKD stages 2-4 (table). Conclusion: Findings from this study suggest that medical costs following HF hospitalization increase by severity of CKD stage, with HF-related costs comprising a large portion of inpatient and outpatient costs.