Resource Utilization and Cost of Heart Failure associated with Reduced Ejection Fraction in Swedish Patients

Abstract

Aim:

The purpose of this study was to assess healthcare utilization and costs for heart failure patients with reduced ejection fraction (HF-REF) in Sweden.

Methods and Results:

This was a retrospective, population-based cohort study of patients diagnosed with HF-REF during a period of 18 months at 31 primary care centers in Uppsala County, Sweden. Data was obtained from computerized records from these centers, the Swedish Patient Registry, the Swedish Prescription Registry, the Cause of Death Registry, and a local echocardiography registry maintained by the Department of Physiology, Uppsala University Hospital. Main outcome measures were cardiovascular and heart-failure-related hospitalizations, outpatient visits, medication utilization, mortality (all-cause, cardiovascular, and heart-failure), and healthcare costs for HF-REF patients. During the index period, 252 heart failure patients had a left ventricular ejection fraction measurement ≤40% and were categorized as having HF-REF. More than half of the patients had ≥1 cardiovascular or heart failure-related hospitalization. On average, patients had >2 such hospitalizations annually. They also averaged ∼1 cardiovascular or heart-failure-related outpatient visit per year. All-cause mortality was high: 15.9% patients died within 1 year after the index date. The mean annual cost per patient for heart-failure-related hospitalizations was SEK 72,613 (EUR 7610). In contrast, annual prescription costs were low, on average 3% of total cost (SEK 3503, EUR 367 per patient)

Limitations:

The main limitations of this study include a short follow-up time and small sample size. Also, certain data were missing, such as echocardiograms (available for only 28% of patients), and information on patients’ New York Heart Association (NYHA) functional class, validity period for prescriptions or the units of medication prescribed, and medication dosing. Furthermore, the overall mortality could have been under-estimated, as only the primary cause of death was included in the analysis.

Conclusions:

The main burden associated with HF-REF is related to hospitalizations for heart-failure events. Effective treatment options that decrease hospitalization rates could reduce patients’ suffering and potentially offer considerable cost savings.

• Reduced ejection fraction heart failure
• Resource utilization
• Direct costs
• Health care cost

Transparency

Declaration of funding

This work was supported by Novartis Pharmaceuticals Corporation

Declaration of financial/other relationships

JS received compensation for his participation in the research. LS, SS, and RP are employed by Analytica International, which received funding for the research. RL is employed by Pygargus AB, which received funding for the research. RA was employed by Novartis Pharmaceuticals Corporation at the time of this research; Novartis provided funding for the research.

Acknowledgments

Thanks to Dr Dan Sandberg for providing data from the from the local echocardiography registry kept by the Department of Physiology, Uppsala University Hospital.

Thanks to Dr. Lars Benson, Luthagens Specialistläkar mottagning, Husläkargruppen in Uppsala and all public Primary Care Centers within Uppsala County Council for contributing with primary care data.

Editorial assistance was provided by Elisabeth Smith and Jacob M. Willet, MPH, both of whom received compensation from Analytica International for their work.

These data have been presented in part at the 2011 Heart Failure Congress, Gothenburg, Sweden (May 21–24).