Abstract
Introduction
Prior research suggests increased costs during the final months of life, yet little is known about healthcare cost differences between patients with heart failure (HF) who die or survive.
Methods
A retrospective claims study from a large US health plan [commercial and Medicare Advantage with Part D (MAPD)] was conducted. Patients were ≥18 years old with two non-inpatient or one inpatient claim(s) with HF diagnosis code(s). The earliest HF claim date during 1 January 2010–31 December 2011 was the index date. Cohort assignment was based on evidence of death within 1 year (decedents) or survival for >1 year (survivors) post-index. Per-patient-per-month (PPPM) and 1-year (variable decedent follow-up) costs (all-cause and HF-related) were calculated up to 1 year post-index. Cohorts were matched on demographic and clinical characteristics. Independent samples t tests and Pearson’s chi-square tests were used to examine cohort differences.
Results
Among patients with HF, 8344 survivors were 1:1 matched to decedents [mean age 75 years, 50% female, 88% MAPD; mean time to decedents’ death: 150 (SD 105) days]. Compared to survivors, more decedents had no pharmacy claims for HF-related outpatient pharmacotherapy within 60 days post-index (42.1% vs. 27.1%; p < 0.001). Decedents also incurred higher all-cause medical costs (PPPM: $21,400 vs. $2663; 1 year: $60,048 vs. $32,394; both p < 0.001) and higher HF-related medical costs (PPPM: $16,477 vs. $1358; 1 year: $39,052 vs. $16,519; both p < 0.001). Hospitalizations accounted for more than half of all-cause PPPM medical costs (54.6% for survivors, 84.3% for decedents).
Conclusion
Patients with HF who died within 1 year after an index HF encounter incurred markedly higher costs within 1 year (despite the much shorter post-index period) and PPPM costs than those who survived, with the majority of costs attributable to hospitalizations for both patient cohorts. There may be opportunities for improving outcomes in HF, considering higher use of pharmacotherapy and lower costs were seen among survivors.
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Acknowledgements
This study and article processing charges were funded by Novartis Pharmaceuticals Corp.
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.
The authors thank Chun-Lan Chang, PhD, for contributions to data interpretation and manuscript development. Medical writing support was provided by Caroline Jennermann, MS, of Optum, funded by Novartis Pharmaceuticals Corp.
Disclosures
At the time of the study, Engels N. Obi was an employee of Rutgers University providing services to Novartis Pharmaceuticals Corp. (NPC) and was reimbursed for travel to present research; he is now an employee of NPC. He has no conflicts to disclose.
Jason P. Swindle is an employee of Optum, Inc., which was contracted by NPC to perform the study; employment was not contingent upon this funding. He has no conflicts to disclose.
Stuart J. Turner is an employee of NPC and has no conflicts to disclose.
Patricia A. Russo provided consulting services to NPC as an employee of DataMed Services, Inc., but she is a current employee of NPC. She has no conflicts to disclose.
Aylin Altan is an employee of Optum, Inc., which was contracted by NPC to perform the study; employment was not contingent upon this funding. She has no conflicts to disclose.
Compliance with Ethics Guidelines
This study was conducted in compliance with the Health Insurance Portability and Accountability Act privacy rules.
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Obi, E.N., Swindle, J.P., Turner, S.J. et al. Healthcare Costs Among Patients with Heart Failure: A Comparison of Costs between Matched Decedent and Survivor Cohorts. Adv Ther 34, 261–276 (2017). https://doi.org/10.1007/s12325-016-0454-y
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DOI: https://doi.org/10.1007/s12325-016-0454-y