Lifetime costs of medical care after heart failure diagnosis

Shannon M Dunlay, Nilay D Shah, Qian D Shi, Bruce Morlan, Holly VanHouten, Kirsten Hall Long, Veronique Lee Roger

Research output: Contribution to journalArticle

121 Citations (Scopus)

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 (ge;50%) were associated with 24.8% (P=0.003) and 23.6% (P=.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.

Original languageEnglish (US)
Pages (from-to)68-75
Number of pages8
JournalCirculation: Cardiovascular Quality and Outcomes
Volume4
Issue number1
DOIs
StatePublished - Jan 2011

Fingerprint

Health Care Costs
Heart Failure
Costs and Cost Analysis
Economics
Hospitalization
Delivery of Health Care
Comorbidity
Inpatients
Diabetes Mellitus
Outpatients
Confidence Intervals
Population

Keywords

  • Community
  • Cost
  • Epidemiology
  • Health services research
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Lifetime costs of medical care after heart failure diagnosis. / Dunlay, Shannon M; Shah, Nilay D; Shi, Qian D; Morlan, Bruce; VanHouten, Holly; Long, Kirsten Hall; Roger, Veronique Lee.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 4, No. 1, 01.2011, p. 68-75.

Research output: Contribution to journalArticle

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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 (ge;50{\%}) were associated with 24.8{\%} (P=0.003) and 23.6{\%} (P=.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.",
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