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. 2023 Oct 28:78:100294.
doi: 10.1016/j.clinsp.2023.100294. eCollection 2024.

Value-based health care in heart failure: Quality of life and cost analysis

Eduarda Chiesa Ghisleni  1 , Vitória Rech Astolfi  2 , Larissa Zimmermann  3 , Camila Nogueira Leandro Lira  4 , Eduarda Faria do Nascimento  5 , Ana Paula Beck da Silva Etges  6 , Fabiana G Marcondes-Braga  4 , Fernando Bacal  7 , Luiz Claudio Danzmann  3 , Carisi Anne Polanczyk  8 , Andreia Biolo  9
Affiliations

Value-based health care in heart failure: Quality of life and cost analysis

Eduarda Chiesa Ghisleni et al. Clinics (Sao Paulo). .

Abstract

Objectives: To measure Quality of Life (QoL) and costs of Heart Failure (HF) outpatients in Brazil as an introduction to the Value-Based Health Care (VBHC) concept.

Materials and methods: Cross-sectional study, patients with HF, with ejection fraction <50%, were recruited from three hospitals in Brazil. Two QoL (36-Item Short Form Survey [SF-36] and Minnesota Living with Heart Failure Questionnaire [MLHFQ]) and two anxiety/depression questionnaires were applied. SF-36 scores were stratified by domains. Treatment costs were calculated using the Time-Driven Activity-Based Costing (TDABC) method. Results were stratified by NYHA functional class and sex.

Results: From October 2018 to January 2021, 198 patients were recruited, and the median MLHFQ (49.5 [IQR 21.0, 69.0]) and SF-36 scores demonstrated poor QoL, worse at higher NYHA classes. A third of patients had moderate/severe depression and anxiety symptoms, and women had higher anxiety scores. Mean costs of outpatient follow-up were US$ 215 ± 238 for NYHA I patients, US$ 296 ± 399 for NYHA II and US$ 667 ± 1012 for NYHA III/IV. Lab/exam costs represented 30% of the costs in NYHA I, and 74% in NYHA III/IV (US$ 63.26 vs. US$ 491.05).

Conclusion: Patients with HF in Brazil have poor QoL and high treatment costs; both worsen as the NYHA classification increases. It seems that HF has a greater impact on the mental health of women. Costs increase mostly related to lab/exams. Accurate and crossed information about QoL and costs is essential to drive care and reimbursement strategies based on value.

Keywords: Costs in health; Heart failure; Patient reported outcomes measures; Quality of life; Value-based health care.

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Conflict of interest statement

Declaration of Competing Interest The authors declare no conflicts of interest.

Figures

Fig 1
Fig. 1
Quality of life stratified by NYHA functional classification. Quality of life according to SF-36 domains and MLHFQ scores stratified by NYHA functional classification. QoL, Quality of Life; PF, Physical Functioning; RP, Role Physical; BP, Body Pain; GH, General Health; Vit, Vitality; SF Social Functioning; RE, Role Emotional; MH, Mental Health; MLHFQ, Minnesota Living with Heart Failure Questionnaire; SF-36, Short Form Health Survey. * p < 0.05 in NYHA I vs. NYHA II, NYHA I vs. NYHA III/IV and NYHA II vs. NYHA III/IV † p < 0.05 in NYHA I vs. NYHA III/IV and NYHA II vs. NYHA III/IV.
Fig 2
Fig. 2
SF-36 domains according to sex. Radar chart plot of SF-36 domains according to gender. Axes for domains (PF, Physical Functioning; RP, Role Physical; BP, Body Pain; GH, General Health; Vit, Vitality; SF, Social Functioning; RE, Role Emotional; MH, Mental Health) are equally scaled from 0 to 100. Higher values indicate a better QoL.
Fig 3
Fig. 3
Quality of life and costs according to NYHA functional classification. Radar chart plot of SF-36 domains and costs according to NYHA functional classification. Axes for domains (PF, Physical Functioning; RP, Role Physical; BP, Body Pain; GH, General Health; Vit, Vitality; SF, Social Functioning; RE, Role Emotional; MH, Mental Health) as well as the reciprocal cost axis are equally scaled from 0 to 100. One hundred percent means the lowest cost. Higher values indicate a better QoL.
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