Diagnostic and lifetime hospital costs of patients suffering from wild-type transthyretin amyloid cardiomyopathy in Denmark

Figures & data

Table 1. Diagnostic tests and costs per patient of diagnostic procedure in patients with ATTRwt in Denmark.

Diagnostic Tests	DRG Rate (USD)	% of Patient	Frequency of procedures per Patient
Blood samples	168	100	1
Echocardiography	396	100	2
Electrocardiography	390	100	2
Bone scintigraphy (DPD)	454	75	1
MR scan of the heart	401	50	1
Genetic risk assessment, consultation and medical examination	684	100	1
Heart biopsy – right side cardiac catheterization	1,832	25	1
Weighted Average Costs per Patient of Diagnostic Procedure	3,424

Note: The reported utilization of each diagnostic tool is based on the authors’ clinical experience in a Danish university hospital. The costs associated with each diagnostic procedure is based on the Danish DRG rates from 2020.

Table 2. Prevalence and Costs per Patient of Cardiac Implants in Patients with ATTRwt in Denmark.

	%	DRG rate (USD)
Prevalence of Patients with Pacemaker	30
Pacemaker implant without complications	99	6,104
Pacemaker implant with complications	1	12,756
Implantable cardioverter-defibrillator	0	67,458
Weighted Average Cost per Patient of Cardiac Implants		6,170

The reported prevalence of cardiac implants and the distribution of cardiac implant types are based on the authors’ clinical experience in a Danish university hospital. The costs associated with each cardiac implant are based on the Danish DRG rates for each of the procedures. DRG rates for cardiac implants are not given separately in the 2020 data. For that reason, we have applied DRG rates from 2017 as an estimate of the costs associated with cardiac implants. The DRG rates have been inflated to 2020 prices using the Danish healthcare cost index²⁵.

Table 3. Hospital Contacts per year prior to diagnosis of ATTRwt and Costs per Hospital Contact of Patients with ATTRwt in Denmark.

Hospital contacts	Investigated			Treated
	No.	No. per patient	DRG rate (USD)	No.	No. per patient	DRG rate (USD)
Ischemic heart disease	21	0.42	390	8	0.16	390
Pulmonary embolus	11	0.22	260	1	0.02	4,616
COPD/asthma	5	0.10	260	3	0.06	3,985
Pneumonia	5	0.10	260	3	0.06	5,364
Atrial fibrillation	18	0.36	168	17	0.34	2,306
Hypertrophic cardiomyopathy	5	0.10	267	0	0	267
Aortic stenosis	11	0.22	168	3	0.06	4,052
Gastric and intestinal disease	5	0.10	339	2	0.04	4,722
Cancer	12	0.24	339	3	0.06	5,504
Others	11	0.22	276	9	0.18	2,828
Total /Weighted Average per 13 months	104	2.08		49	0.98
Weighted Average per year		1.92	276		0.90	2,828

The numbers reported in the table are based on data published in Ladefoged et al.¹⁰. The costs associated with investigation and treatment of each listed disease are based on relevant DRG rates from 2020. Moreover, we assume that investigations are performed during an outpatient care vist and that treatment of the listed diseases requires an inpatient hospitalization. The reported number of yearly hospitalizations in the years prior to diagnosis is based on the data published in Ladefoged et al. (2020) and adjusted to yearly hospitalization rates (n/13*12).The costs associated with investigations and treatments of “other” diseases are set to the weighted average of the costs of the identified diseases. Similarly, the reported weighted averages of the DRG rate of USD 276 for investigations and USD 2,828 for treatments are calculated as the weighted averages of the cost associated with investigation and treatment of the relevant diseases.

Table 4. Case Mix of Inpatient Stays Following Diagnosis of ATTRwt, and Average Weighted Costs of Patients with ATTRwt in Denmark.

Diagnosis and Procedure Group	DRG rate (USD)	% of Admissions
Heart failure and shock	4,972	14.39
Stable ischemic heart disease/chest pain	390	2.88
Acute myocardial infarction with ST-segment elevation	2,678	1.44
Stable ischemic heart disease, procedure group A	10,957	1.44
Heart failure, incl. cardiac shock, procedure group C	10,957	11.51
Heart failure, incl. cardiac shock, procedure group B	7,600	11.51
Heart failure, incl. cardiac shock, procedure group A	4,456	11.51
Other heart diseases	267	8.63
Rehabilitation after cardiac event	3,089	0.72
Other heart diseases, procedure group C	11,669	8.63
Other heart diseases, procedure group B	4,924	8.63
Other heart diseases, procedure group A	2,330	8.63
Cardiac arrhythmia syncope	2,306	10.07
Total weighted average	5,483	100

The reported proportion of admission within each reference pricing category is based on the authors’ clinical experience in a Danish university hospital. The costs associated with hospitalizations within each category are based on the relevant Danish DRG rates from 2020.

Table 5. Hospital Contacts per year after diagnosis of ATTRwt and Costs per Hospital Contact in Patients with ATTRwt in Denmark.

Hospital Contacts per Year After Diagnosis	No. of contacts	DRG rate (USD)
Inpatient hospitalizations	2.33	5,483
Ambulatory visits	4.50	168
Emergency room visits	1	168

Yearly inpatient hospitalization rates and emergency room visits are based on Lane et al.⁹. The number of yearly ambulatory visits are based on the authors’ clinical experience in a Danish university hospital.

The costs associated with each hospitalization category are calculated as the weighted average of the relevant Danish DRG rates from 2020 within each category.

Table 6. Total diagnostic and lifetime hospital costs of patients with ATTRwt in Denmark.

Total Costs of ATTRwt	Costs (USD)	% share
Diagnostic procedure	3,424	5.0
Cardiac implants	1,851	2.7
Hospitalizations prior to diagnosis	3,345	4.9
Hospitalizations after diagnosis	59,449	87.3
Total Cost	68,069	100

The table reports the estimated cost within each defined category. The reported costs for the period prior to diagnosis includes hospitalization costs 13 months prior to diagnosis. Similarly, the reported costs after diagnosis assumes a mean life expectancy of 52 months. Numbers are rounded.

Table 7. Deterministic sensitivity analyses.

	Total lifetime cost (USD)	% compared to the baseline results
Baseline	68,069
Frequency of cardiac implant increased to 45%	68,944	1.36
Frequency of cardiac implant reduced to 15%	67,143	−1.36
Cost of inpatient hospitalizations increased by 50%
Prior to diagnosis	69,454	2.04
After diagnosis	95,788	40.72
Cost of inpatient hospitalizations reduced by 50%
Prior to diagnosis	66,683	−2.04
After diagnosis	40,349	−40.72
Cost of outpatient hospital care increased by 50%
Prior to diagnosis	68,356	0.42
After diagnosis	69.709	2.41
Cost of outpatient hospital care reduced by 50%
Prior to diagnosis	67,782	−0.42
After diagnosis	66.429	−2.41
Number of inpatient hospitalizations sat to 0.7 per year	29,262	−57.01
Time horizon prior to diagnosis (increased to 39 months)	74,758	9.83
Time horizon after diagnosis (increased to 68 months)	79,592	16.93
Time horizon after diagnosis (reduced to 26 months)	38,344	−43.67
All parameters increased by 17%	109,679	61.13
All parameters reduced by 17%	39,539	−41.91

The table reports the estimated lifetime hospitalization costs for a range of deterministic sensitivity analyses.

Figure 1. Estimates from deterministic sensitivity analyses. The figure presents the estimates of the total lifetime hospital cost (USD) associated with ATTRwt from each of the sensitivity analyses.

Danske Regioner. Danske Regioner - Økonomisk Vejledning 2020 n.d. https://www.regioner.dk/aftaler-og-oekonomi/oekonomisk-vejledning/oekonomisk-vejledning-2020. (accessed Jun 7, 2020).

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 PubMed Web of Science ®Google Scholar