Abstract
IntroductionHeart failure (HF) is a major public health concern, prevalent in millions of people worldwide. The most widely-used HF diagnostic method, echocardiography, incurs a decreased diagnostic accuracy for heart failure disease progression when patients are asymptomatic compared to those who are symptomatic. The purpose of this study is to conduct a cost-effectiveness analysis of heart failure diagnosis comparing echocardiography to a novel myocardial strain assessment (Fast-SENC), which utilizes cardiac-tagged magnetic resonance imaging.MethodsWe develop two models, one from the perspective of payers and one from the perspective of purchasers (hospitals). The payer model is a cost-effectiveness model composed of a 1-year short-term model and a lifetime horizon model. The hospital/purchaser model is a cost impact model where expected costs are calculated by multiplying cost estimates of each subcomponent by the accompanying probability.ResultsThe payer model shows lower healthcare costs for Fast-SENC in comparison to ECHO ($24,647 vs. $39,097) and a lifetime savings of 37% when utilizing Fast-SENC. Similarly, the hospital model revealed that the total cost per HF patient visit is $184 for ECHO and $209 for Fast-SENC, which results in hospital contribution margins of $81 and $115, respectively.ConclusionsFast-SENC is associated with higher quality-adjusted life years and lower accumulated expected healthcare costs than echocardiogram patients. Fast-SENC also shows a significant short-term and lifetime cost-savings difference and a higher hospital contribution margin when compared to echocardiography. These results suggest that early discovery of heart failure with methods like Fast-SENC can be cost-effective when followed by the appropriate treatment.
Highlights
Heart failure (HF) is a major public health concern, prevalent in millions of people worldwide
The total cost per HF patient visit is $184 for ECHO and $209 for Fast-SENC, which results in hospital contribution margins of $81 and $115, respectively
We found that Fast-SENC was associated with higher quality-adjusted life years (1.96 v .88) and, over a lifetime, patients in the Fast-SENC cohort accumulated $24,647 per patient in expected healthcare costs compared to the higher costs in the ECHO group ($39,097 per patient)
Summary
Heart failure (HF) is a major public health concern, prevalent in millions of people worldwide. Heart failure (HF) is a major public health concern, with a prevalence of 1–2%, or more than 5.8 million people in the U.S and over 23 million worldwide [1, 2]. The increasing prevalence is due in part to the aging of the population, increasing rates of obesity and diabetes, and more generally the prolongation of the lives of cardiac patients [4,5,6,7]. The outcomes for ambulatory HF patients with a reduced ejection fraction have improved with the innovation of drug and device therapies, hospitalized HF patients continue to experience high post-discharge mortality and readmission rates [4]. Heart failure is associated with a disproportionately higher use of ambulatory
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