Lifetime costs of medical care after heart failure diagnosis

Abstract

Background: Heart failure (HF) care constitutes an increasing economic burden on the health care system, and has become a key focus in the health care debate. However, there are limited data on the lifetime health care costs for individuals with HF after initial diagnosis.

Methods and results: Olmsted County residents with incident HF from 1987 to 2006 were identified. Direct medical costs incurred from the time of HF diagnosis until death or last follow-up were obtained using population-based administrative data through 2007. Costs were inflated to 2008 US dollars using the general Consumer Price Index. Inpatient, outpatient, and total costs were estimated using a 2-part model with adjustment for right censoring of data. Predictors of total costs were examined using a similar model. A total of 1054 incident HF patients were identified (mean age, 76.8 years; 46.1% men). After a mean follow-up of 4.6 years, 765 (72.6%) patients had died. The estimated total lifetime costs were $109 541 (95% confidence interval, $100 335 to 118 946) per person, with the majority accumulated during hospitalizations (mean, $83 980 per person). After adjustment for age, year of diagnosis, and comorbidity, diabetes mellitus and preserved ejection fraction (≥50%) were associated with 24.8% (P=0.003) and 23.6% (P=0.041) higher lifetime costs, respectively. Higher costs were observed at initial HF diagnosis and in the months immediately before death in those surviving >12 months after diagnosis.

Conclusions: HF imposes a significant economic burden, primarily related to hospitalizations. Variations in cost over a lifetime can help identify strategies for efficient management of patients, particularly at the end of life.

Figure 1. Distribution of Costs over Lifetime

A representative distribution of the distribution of medical costs from the time of HF diagnosis until death by month is shown for those surviving 36–48 months after diagnosis (n=95, panel A). A similar distribution in costs over time was observed for those surviving from 12–36 and 48–96 months. Costs for those surviving <12 months (n=166) followed a different pattern (panel B).

Figure 1. Distribution of Costs over Lifetime

A representative distribution of the distribution of medical costs from the time of HF diagnosis until death by month is shown for those surviving 36–48 months after diagnosis (n=95, panel A). A similar distribution in costs over time was observed for those surviving from 12–36 and 48–96 months. Costs for those surviving <12 months (n=166) followed a different pattern (panel B).