PCV9: AN ECONOMIC ANALYSIS OF CONGESTIVE HEART FAILURE (CHF) IN THE LOUISIANA MEDICAID PROGRAM

Abstract

OBJECTIVE: To examine the cost of illness of Congestive Heart Failure (CHF) in the Louisiana Medicaid program. METHODS: Study design: A retrospective review of the medical and pharmacy claims data (1999–2000) in the Louisiana Medicaid program. We reviewed pharmacy and medical claims data for the years 1999–2000 from the Louisiana Medicaid program. The data were obtained from Unisys, the fiscal intermediary for the Louisiana Medicaid program, in a PC compatible format. We extracted the claims for CHF patients on the basis of the ICD-9-CM codes. A total of 13,947 patients met the study criteria, which included at least one primary or secondary diagnosis of CHF and availability of claims data for at least one year after the first CHF diagnosis related claim. We reviewed all the charges incurred for a one-year period after the initial CHF claim. RESULTS: The total cost for CHF patients for one year was over $182 million. The majority of the patients (73.63%) were female and accounted for 70% of the total cost. The mean age was 70 years and the largest portion of the total cost (55%) came from those 65 years and older. Of the 13,947 patients 11,065 (79%) were hospitalized at an average cost of $4,679 per hospitalized patient. Approximately 87% of the study population received prescription drugs at an average cost of $2,897 per prescription drug user. Hospitalizations and prescription drugs contributed 28% and 19.38% respectively to the total cost. Almost one third of the total cost was due to long-term care at $13,817 per utilizer. Costs for CHF diagnosis related claims were 14% of all costs. CONCLUSION: CHF represents a significant financial burden from the perspective of the Louisiana Medicaid program. Improved management of the condition is needed to reduce the cost of treatment associated with CHF.