Clinical Investigation
The Cost of Medical Management in Advanced Heart Failure During the Final Two Years of Life

https://doi.org/10.1016/j.cardfail.2008.06.005Get rights and content

Abstract

Objective

To examine patterns of resource use and the cost of care for patients with advanced heart failure treated with medical management (MM) during the final 2 years of life.

Methods and Results

The study population (n = 47, mean age 70.4 years ± 7.06) included patients randomized to the MM arm of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure trial. Inpatient and outpatient use data were obtained from the clinical dataset and Centers for Medicare and Medicaid Services (beginning January 1, 1998). Cost and resource use were tracked from the date of death (td) backward in 3-month intervals (eg, td-1, td-2). In the primary analysis, costs were summed across intervals. The mean cost of MM in the final 2 years of life was $156,169, with 50.5% ($78,880.39) expended in the final 6 months. The mean quarterly cost increased (P < .01) 4.9-fold from td-8 ($8,816 ± $14,270) to td-1 ($42,836 ± $41,407). The number of inpatient days increased (P < .01) 6.6-fold from 3.8 ± 4.7 days to 22.2 ± 23.5 days during the same time intervals.

Conclusion

This current economic analysis extends on previous findings by demonstrating that medical therapy in advanced and end-stage heart failure is associated with significant costs and resource consumption; these costs and resource consumption increase significantly as death approaches.

Section snippets

Study Population

This study analyzes cost and resource use related to the medical treatment of advanced heart failure and ESHF. The study population includes Medicare beneficiaries enrolled in the REMATCH trial and randomized to MM.9 Among this group (n = 61), 47 patients had detailed costing data from the Centers for Medicare and Medicaid Services (CMS). Patients eligible for REMATCH included adults with chronic ESHF (Class IV) and contraindications to transplantation; eligibility criteria, including detailed

Study Population

The study population was predominantly male (84%), 16% of patients were of Hispanic or African American origin, and the majority (71%) had ischemic cardiomyopathy (Table 1). The mean age of death was 70.4 years (±7.06). The adjudicated cause of death for 96% of patients was progression of heart failure.

Cost

The mean total cost of medical therapy per patient for chronic ESHF during the final 2 years of life was $156,168.52 (Table 2). The mean total costs by quarter increased (P < .01) 4.9-fold from

Discussion

With more than 95% of patients with advanced heart failure treated with MM alone, a better understanding of resource use in this population will allow greater insights into the economics of heart failure therapy. To characterize cost and resource use of patients with advanced heart failure as they progress to death, this study used detailed, comprehensive, and audited data collected from a small but well-characterized population of patients with heart failure. These patients were managed with

Conclusions

This current economic analysis extends on previous findings by demonstrating that medical therapy in advanced heart failure and ESHF is associated with significant costs and resource consumption. The mean total cost of medical therapy per patient for patients with advanced heart failure during the final 2 years of life was estimated to be $156,168. Costs and resource use in patients with advanced heart failure increased as death approached, with more than 50% of the total costs incurred in the

Acknowledgments

We thank the REMATCH Investigators, Cuiling Wang, PhD, and Lopa Gupta, MPH, for assistance with the preparation of this article.

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  • Cited by (0)

    Presented at the 2006 American Heart Association Scientific Sessions, November 12 to 15, 2006, Chicago, Illinois.

    The REMATCH trial was supported, in part, by a cooperative agreement (HL-53986) funded by the National Heart Lung and Blood Institute of the National Institutes of Health, Bethesda, Maryland, and Thoratec Corporation, Pleasanton, California. Additional funding for the routine costs of clinical care associated with the trial was made available by the Center for Medicare and Medicaid Services and by the participating clinical centers. Reprint requests: Mark J. Russo, MD, MS, New York-Presbyterian Hospital/Columbia, Milstein Hospital Bldg, Room 7-435 GN, 177 Fort Washington Avenue, New York, NY 10032.

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