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Observational Study
. 2021 Jun;8(3):1915-1923.
doi: 10.1002/ehf2.13155. Epub 2021 Mar 10.

Resource utilization and costs among patients with heart failure with reduced ejection fraction following a worsening heart failure event

Michael M Givertz  1 , Mei Yang  2 , Gregory P Hess  3 , Bin Zhao  2 , Ashwin Rai  4 , Javed Butler  5
Affiliations
Observational Study

Resource utilization and costs among patients with heart failure with reduced ejection fraction following a worsening heart failure event

Michael M Givertz et al. ESC Heart Fail. 2021 Jun.

Abstract

Aims: The aim of this study is to characterize healthcare resource utilization and costs in patients with heart failure with reduced ejection fraction (HFrEF) following a worsening heart failure event.

Methods and results: This was a retrospective observational cohort analysis. Patients with HFrEF were identified from the PINNACLE Registry and linked to a nationwide pharmacy and medical claims database. Worsening heart failure was defined as stable heart failure with a subsequent hospitalization and/or intravenous diuretic therapy. Healthcare resource use and costs in 2015 US dollars were analysed for dispensed prescriptions, outpatient encounters, and hospital encounters. Among 11 064 patients with HFrEF, 3087 (27.9%) experienced a worsening heart failure event during an average follow-up of 973 days. During the first 30 days after the worsening event, 19.8% of patients had hospital readmissions with heart failure as the primary or secondary diagnosis. During that same time period, mean per patient heart failure-related healthcare resource use included 1.3 prescriptions, 0.5 practitioner visits, and 0.5 hospital encounters (admissions, observations, or emergency care), for an average total medical cost of $8779 per patient including $5359 in heart failure-related costs. During the first year following worsening heart failure onset, mean per patient total and heart failure-related costs were $62 615 and $35 329, respectively.

Conclusions: The economic burden following a worsening heart failure event calls for further review of methods to prevent progressive disease, improve adherence to guideline-directed therapy, and develop novel treatments and care strategies to moderate further progression.

Keywords: Cost and cost analysis/economics; Health resources; Heart failure/complications; Hospitalization.

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Conflict of interest statement

M. Givertz has research support from the National Institutes of Health and serves as a consultant to Merck. J. Butler has received research support from the National Institutes of Health, PCORI, and the European Union and serves as a consultant for Amgen, Array, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squib, CVRx, G3 Pharmaceutical, Innolife, Janssen, Luitpold, Medtronic, Merck, Novartis, Relypsa, StealthPeptide, SC Pharma, Vifor, and ZS Pharma. G. Hess was previously employed by Symphony Health, which received research support from Merck & Co. for the design and conduct of this study. G. Hess also conducts funded studies with governmental agencies, for example, the NIH, and professional societies, for example, the American College of Cardiology. M. Yang and B. Zhao are employees of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., and are shareholders of Merck & Co., Inc., Kenilworth, NJ, USA.

Figures

Figure 1
Figure 1
Study design. ED, emergency department; HFrEF, heart failure with reduced ejection fraction; IV, intravenous; LVEF, left ventricular ejection fraction.
Figure 2
Figure 2
Healthcare resource utilization per person per month following a worsening heart failure event for (A) prescriptions, (B) outpatient encounters, and (C) hospital encounters. The number of patients available at each time point were n = 3087 at 1 month, n = 2984 at 3 months, n = 2859 at 6 months, n = 2749 at 9 months, n = 2672 at 12 months, n = 1799 at 18 months, and n = 1277 at 24 months. Outpatient encounters include office and clinic visits. Hospital encounters include admissions, observational visits, and emergency department visits.
Figure 3
Figure 3
Total cumulative mean adjusted utilization costs following a worsening heart failure event. Costs are in US dollars, inflation‐adjusted for 2015.
See this image and copyright information in PMC

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