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West-German Heart Center, Cardiology, University Hospital Essen
Economic burden of patients with various etiologies of chronic systolic heart failure analyzed by resource use and costs
J. Biermann1,2, A. Neumann2, C.E. Angermann3, R. Erbel1, B. Maisch4, D. Pittrow5, V. Regitz-Zagrosek6, T. Scheffold7, R. Wachter8, G. Gelbrich9, J. Wasem2, T. Neumann1
on behalf of the German Competence Network Heart Failure
1 Clinic of Cardiology, University Hospital Essen, Essen, Germany | 2 Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany | 3 Department of Internal Medicine I and Comprehensive Heart Failure Center, University Hospital Würzburg, Germany | 4 Department of Internal Medicine, Cardiology, University Hospital
Giessen and Marburg, Marburg, Germany | 5 Department for Clinical Pharmacology, Medical Faculty, Carl Gustav Carus, Technical University of Dresden, Germany | 6 Department of Cardiovascular Diseases in Women, Charité University Medicine, Berlin, Germany | 7 Institute for Heart and Circulation Research, University of Witten/Herdecke, Dortmund,
Germany | 8 Department of Cardiology and Pneumology, Georg-August University Göttingen, Göttingen, Germany | 9 Clinical Trial Centre Leipzig (KKS), University of Leipzig, Leipzig, Germany
Correspondence: Prof. Dr. Till Neumann, Janine Biermann | Clinic of Cardiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany | Phone: +49(0)201-723-4806 | Mail: Till.Neumann@uk-essen.de, Janine.Biermann@uk-essen.de
Purpose
Results
Chronic heart failure is a major cardiac disease, going along
with a high economic burden. Diagnostic and therapy differ
depending on etiology of chronic heart failure. The present
work analyses disease-related resource use and associated
costs of systolic chronic heart failure with respect to the
etiology of the disease.
The following results are based on 2,710 patients (female 25.2%; 62.9
± 13.6 years) of the CNHF with systolic CHF (table 1). The mean
LVEF in the patient population was 31.3 ± 9.0%. Of all patients, 61.3%
had a LVEF between 30 and 50 %, whereas 38.7% had LVEF <30%.
The most common cause of heart failure was dilated cardiomyopathy
(47.4%), followed by coronary artery disease (33.5%). The majority of
patients were in NYHA functional classes II (51.7%) and III (38.1%).
During one year, patients had on average 6.1 contacts to their
general practitioner, 1.7 contacts to cardiologists and 0.8 hospital
stays per year (see table 2).
Overall care costs per patient were 3,150€ per year. Costs of inpatient
care were the largest component of direct costs (2,622€) thus
representing 83%. Costs of medication (290€) and outpatient
physician contacts (238€) were significantly lower (see table 3 and
figure 1). Over-average costs of heart failure care appeared in patients
with
hypertrophic
cardiomyopathy
(4,681€)
and
dilated
cardiomyopathy (3,596€), while patients with heart failure due to
coronary artery disease (3,046€) and arterial hypertension (1,039€)
exhibited significantly lower resource use and costs per year.
Methods
From the database of the German Competence Network Heart
Failure, 2,710 individuals with systolic chronic heart failure
(mean age 62.9 years ± 13.6, 25.2% female, 89.8% NYHA
II/III) were included into analyses. Resource use was
assessed with regard to outpatient contacts, hospitalizations
including rehabilitation, and drug utilization.
Table 1. Patient characteristics
n (%)
DCM
CAD
1,285 (47.4)
907 (33.5)
HHD
HCM
NCD
Total
117 (4.3)
41 (1.5)
360 (13.3)
2710 (100)
Table 3. Annual costs per patient (€)
Sex
(% female)
BMI
[kg/m2]
56.5 ± 13.6
69.0 ± 10.3
71.6 ± 10.0
56.5 ± 12.6
67.9 ± 11.1
62.9 ± 13.6
23.2
22.5
41.9
39.0
32.5
25.2
27.6 ± 4.9
27.6 ± 4.8
29.0 ± 5.9
27.3 ± 5.6
27.6 ± 5.1
27.6 ± 5.0
Haemodynamics
Systolic BP
119.2 ±
18.0
123.8 ± 19.6
136.2 ± 23.2
123.6 ± 18.6
127.9 ± 21.3
122.7 ± 19.7
Diastolic BP
73.4 ± 11.4
72.3 ± 11.4
77.5 ± 12.4
74.4 ± 10.5
74.7 ± 12.2
73.4 ± 11.6
76.9 ± 16.4
74.3 ± 16.0
80.9 ± 18.4
73.0 ± 16.0
78.1 ± 19.5
76.3 ± 16.9
Heart rate
[min-1]
NYHA [n (%)]
Class
I
105 (8.2)
52 (5.7)
3 (2.6)
3 (7.3)
34 (9.4)
197 (7.3)
II
666 (51.8)
473 (52.1)
66 (56.4)
19 (46.3)
177 (49.2)
1401 (51.7)
III
477 (37.1)
357 (39.4)
44 (37.6)
17 (41.5)
138 (38.3)
1033 (38.1)
IV
37 (2.9)
25 (2.8)
4 (3.4)
2 (4.9)
11 (3.1)
79 (2.9)
Echocardiography
LVEF [%]
28.8 ± 8.8
33.1 ± 8.4
34.4 ± 8.5
36.4 ± 8.8
34.2 ± 8.6
31.3 ± 9.0
LVDD [mm]
66.7 ± 9.5
59.0 ± 9.1
57.1 ± 8.3
53.1 ± 9.5
58.8 ± 8.9
62.4 ± 10.1
All values expressed as mean ± SD. BMI: Body mass index, BP: Blood pressure, CAD: Coronary artery disease, DCM: dilated
cardiomyopathy, HCM: hypertrophic cardiomyopathy, HHD: hypertensive heart disease, LVEF: left ventricular ejection fraction,
LVDD: left ventricular end-diastolic diameter, NCD: not clearly determined, NYHA: New York Heart Association Functional
Classification.
CAD
HHD
HCM
NCD
Total
265
220
155
429
193
238
General practitioner
119
122
105
154
109
118
Cardiologist
146
98
50
275
85
120
Subtotal
Medication
336
258
221
250
232
290
Beta blockers
93
92
69
78
81
90
ACE inhibitors
23
22
21
20
20
23
AT1 receptor
antagonists
36
39
46
11
34
37
Aldosterone
antagonists
142
84
56
114
70
109
Cardiac glycosides
42
21
28
28
28
32
2,730
2,155
575
3,707
1,638
2,328
Subtotal
Physician
Hospital
(inpatient stays)
Rehabilitation
(inpatient)
∑
265
412
88
294
294
294
3,597
3,046
1,039
4,681
2,358
3,150
All costs were adjusted for the year 2009. CAD: coronary artery disease, DCM: dilated cardiomyopathy, HCM: hypertrophic
cardiomyopathy, HHD: hypertensive heart disease, NCD: not clearly determined.
Table 2. Etiology-related resource use
Demographics
Age
DCM
number
DCM
CAD
HHD
HCM
NCD
Total
Figure 1. Cost structure
9%
Contacts to General Practitioner
8%
9%
0-1
41.5%
35.0%
51.3%
31.7%
39.2%
39.3%
2-4
24.1%
29.0%
17.1%
22.0%
27.2%
25.8%
5-12
21.7%
24.3%
19.7%
31.7%
22.8%
22.8%
>12
12.6%
11.8%
12.0%
14.6%
10.8%
12.1%
6.2 ± 8.8
6.3 ± 9.6
5.4 ± 8.0
8.0 ± 9.9
5.6 ± 8.2
6.1 ± 9.0
0-1
50.0%
63.7%
81.2%
34.2%
71.7%
58.5%
2-4
40.9%
31.8%
17.1%
46.3%
22.8%
34.5%
Subtotal Physician
Subtotal Medication
5-12
8.2%
4.1%
1.7%
14.6%
5.3%
6.2%
Hospital (inpatient stays)
Rehabilitation (inpatient)
>12
0.9%
0.4%
0.0%
4.9%
0.3%
0.7%
2.1 ± 2.8
1.4 ± 2.0
0.7 ± 1.3
4.0 ± 5.2
1.2 ± 1.9
1.7 ± 2.5
Mean ± SD
Contacts to Cardiologist
Mean ± SD
74%
Inpatient Hospital Stays
0
44.6%
54.5%
82.1%
41.5%
59.4%
51.4%
1
32.5%
30.2%
16.2%
26.8%
29.4%
30.6%
2+
22.9%
15.3%
1.7%
31.7%
11.1%
18.0%
1.0 ± 1.2
0.8 ± 1.3
0.2 ± 0.4
1.3 ± 1.5
0.6 ± 0.9
0.8 ± 1.2
91.4%
Mean ± SD
Inpatient Rehabilitation Stays
0
91.2%
89.9%
97.4%
90.2%
93.9%
1+
8.8%
10.1%
2.6%
9.8%
6.1%
8.6%
0.09 ± 0.3
0.14 ± 0.8
0.03 ± 0.2
0.1 ± 0.3
0.1 ± 0.5
0.1 ± 0.5
Mean ± SD
All values expressed as mean ± SD. CAD: Coronary artery disease, DCM: dilated cardiomyopathy, HCM: hypertrophic
cardiomyopathy, HHD: hypertensive heart disease, NCD: not clearly determined.
Conclusions
Heart failure is associated with a high economic burden. Patients
with non-vascular forms of heart failure require an over-average
resource use primarily due to hospital admissions. Efficient
treatment strategies have to consider these aspects for optimizing
care and to delimitate the economic costs of heart failure care.
Declaration of interest
No declarations of interest
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