Contemporary economic burden in a real-world heart failure population with Commercial and Medicare supplemental plans.

Carolyn S P Lam,Theo Tritton,Muthiah Vaduganathan,Joseph Thomas,Gabriela Luporini Saraiva,Robert Wood,Lei Qin,Elisabeth Sörstadius,Alex Chin,Hector Bueno

doi:10.1002/clc.23585

Abstract

BackgroundLimited real‐world data exist on healthcare resource utilization (HCRU) and associated costs of patients with heart failure (HF) with reduced ejection fraction (HFrEF) and preserved EF (HFpEF), including urgent HF visits, which are assumed to be less burdensome than HF hospitalizations (hHFs)HypothesisThis study aimed to quantify the economic burden of HFrEF and HFpEF, via a retrospective, longitudinal cohort study, using IBM® linked claims/electronic health records (Commercial and Medicare Supplemental data only).MethodsAdult patients, indexed on HF diagnosis (ICD‐10‐CM: I50.x) from July 2012 through June 2018, with 6‐month minimum baseline period and varying follow‐up, were classified as HFrEF (I50.2x) or HFpEF (I50.3x) according to last‐observed EF‐specific diagnosis. HCRU/costs were assessed during follow‐up.ResultsAbout 109 721 HF patients (22% HFrEF, 31% HFpEF, 47% unclassified EF; median 18 months' follow‐up) were identified. There were 3.2 all‐cause outpatient visits per patient‐month (HFrEF, 3.3; HFpEF, 3.6); 69% of patients required inpatient stays (HFrEF, 80%; HFpEF, 78%). Overall, 11% of patients experienced hHFs (HFrEF, 23%; HFpEF, 16%), 9% experienced urgent HF visits (HFrEF, 15%; HFpEF, 12%); 26% were hospitalized less than 30 days after first urgent HF visit versus 11% after first hHF. Mean monthly total direct healthcare cost per patient was $9290 (HFrEF, $11 053; HFpEF, $7482).ConclusionsHF‐related HCRU is substantial among contemporary real‐world HF patients in US Commercial or Medicare supplemental health plans. Patients managed in urgent HF settings were over twice as likely to be hospitalized within 30 days versus those initially hospitalized, suggesting urgent HF visits are important clinical events and quality improvement targets.

Highlights

Heart failure (HF) is an important cause of mortality and morbidity,[1] yet has broader health implications, including substantial economic burden on healthcare systems
Increasing heart failure (HF) prevalence[4] is expected to drive HF-related direct costs to $53 billion by 2030.5 Despite recognition of the economic burden of HF, limited data exist estimating the impact on healthcare resource utilization (HCRU) and direct medical costs of HF management across care settings
Even less information exists on cost and HCRU variation according to left ventricular ejection fraction (LVEF), patients with HF with preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF), despite increasing awareness of the burden of HFpEF.[6]

Summary

Introduction

Heart failure (HF) is an important cause of mortality and morbidity,[1] yet has broader health implications, including substantial economic burden on healthcare systems. Even less information exists on cost and HCRU variation according to left ventricular ejection fraction (LVEF), patients with HF with preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF), despite increasing awareness of the burden of HFpEF.[6] The primary study aim was to estimate HCRU and associated direct medical costs, including HF hospitalizations (hHFs) and urgent HF visits, in a contemporary HF-patient cohort. Limited real-world data exist on healthcare resource utilization (HCRU) and associated costs of patients with heart failure (HF) with reduced ejection fraction (HFrEF) and preserved EF (HFpEF), including urgent HF visits, which are assumed to be less burdensome than HF hospitalizations (hHFs) Hypothesis: This study aimed to quantify the economic burden of HFrEF and HFpEF, via a retrospective, longitudinal cohort study, using IBM® linked claims/electronic health records (Commercial and Medicare Supplemental data only). Patients managed in urgent HF settings were over twice as likely to be hospitalized within 30 days versus those initially hospitalized, suggesting urgent HF visits are important clinical events and quality improvement targets

Objectives

Methods

Results