Healthcare resource utilisation and costs associated with a heart failure diagnosis: a retrospective, population-based cohort study in Sweden

Abstract

Objectives: To examine healthcare resource use (HRU) and costs among heart failure (HF) patients using population data from Sweden.

Design: Retrospective, non-interventional cohort study.

Setting: Two cohorts were identified from linked national health registers (cohort 1, 2005-2014) and electronic medical records (cohort 2, 2010-2012; primary/secondary care patients from Uppsala and Västerbotten).

Participants: Patients (aged ≥18 years) with primary or secondary diagnoses of HF (≥2 International Classification of Diseases and Related Health Problems, 10th revision classification) during the identification period of January 2005 to March 2015 were included.

Outcome measures: HRU across the HF phenotypes was assessed with logistic regression. Costs were estimated based on diagnosis-related group codes and general price lists.

Results: Total annual costs of secondary care of prevalent HF increased from SEK 6.23 (€0.60) to 8.86 (€0.85) billion between 2005 and 2014. Of 4648 incident patients, HF phenotype was known for 1715: reduced ejection fraction (HFrEF): 64.5%, preserved ejection fraction (HFpEF): 35.5%. Within 1 year of HF diagnosis, the proportion of patients hospitalised was only marginally higher for HFrEF versus HFpEF (all-cause (95% CI): 64.7% (60.8 to 68.4) vs 63.7% (60.8 to 66.5), HR 0.91, p=0.14; cardiovascular disease related (95% CI): 61.1% (57.1 to 64.8) vs 60.9% (58.0 to 63.7), HR 0.93, p=0.28). Frequency of hospitalisations and outpatient visits per patient declined after the first year. All-cause secondary care costs in the first year were SEK 122 758 (€12 890)/patient/year, with HF-specific care accounting for 69% of the costs. Overall, 10% of the most expensive population (younger; predominantly male; more likely to have comorbidities) incurred ~40% of total secondary care costs.

Conclusions: HF-associated costs and HRU are high, especially during the first year of diagnosis. This is driven by high hospitalisations rates. Understanding the profile of resource-intensive patients being at younger age, male sex and high Charlson comorbidity index scores at the time of the HF diagnosis is most likely a sign of more severe disease.

Keywords: adult cardiology; health economics; heart failure.

Figure 1

Mean number of hospitalisations (lines in black) and outpatient visits (lines in grey) for incident patients with HF during 2010–2012 by year after HF diagnosis. Number of patients 1, 2 and 3 years after diagnosis: 4648, 2769 and 1309 total patients; 1106, 667 and 323 patients with HFrEF; 609, 353 and 156 patients with HFpEF; 2933, 1749 and 830 with unknown LVEF, respectively. CVD, cardiovascular disease; HF, heart failure; HFpEF, HF with preserved ejection fraction; HFrEF, HF with reduced ejection fraction; LVEF, left ventricular ejection fraction.

Figure 2

All-cause, CVD-related and HF-related total, inpatient and outpatient costs up to 3 years after diagnosis of HF (incident patients with HF, 2010–2012). Number of patients: year 1, n=4648; year 2, n=2769; year 3, n=13 095. All costs are given in SEK 2015 values (1 SEK=€0.105). CVD, cardiovascular disease; HF, heart failure; SEK, Swedish krona.