Background
The burden of heart failure
Background on cost-of-illness studies
Perspective
Epidemiological approach
Method of resource quantification
Objectives
Methods
Inclusion and exclusion criteria
General characteristics of the studies
Standardization of costs
Results
Study characteristics
Reference | Country | Study size | Epidemiological approach | Method of Resource Quantification | Study period | Perspective | Study design | Mean age |
---|---|---|---|---|---|---|---|---|
Voigt 2014 [35] | USA | – | Prevalenta | Mixeda | 2007–2012 | Sa | R | – |
Corrao 2014 [33] | Italy | 26,949 | Incident | Top-downa | 2011 | P | R | 79 |
Czech 2013 [36] | Poland | – | Prevalenta | Mixeda | 2009–2011 | P | R | – |
Delgado 2013 [37] | Spain | 374 | Prevalenta | Bottom-upa | 2010 | S | Pr | 62 |
Dunlay 2011 [34] | USA | 1054 | Incidenta | Top-downa | 1987–2006 | Pa | R | 76,8 |
Bogner 2010 [24] | USA | 7996 | Prevalenta | Bottom-upa | 2000–2001 | P | R | 77,8–81,4 |
Zugck 2010 [30] | Germany | 86,493 | Prevalenta | Top-downa | 2002 | Pa | R | – |
Neumann 2009 [29] | Germany | – | Prevalenta | Top-downa | 2000–2007 | Pa | R | – |
Liao 2007 [23] | USA | 4860 | Prevalent | Top-down | 1992–2003 | Pa | Pr | 75,6- 78,2 |
Liao 2006 [25] | USA | 881 | Mixed | Top-down | 1992–1998 | Pa | Pr | 77,6- 81,6 |
Agvall 2005 [28] | Sweden | 115 | Prevalenta | Bottom-upa | 1999–2000 | Pa | R | 77 |
Ory 2005 [26] | USA | 17,835 | Mixed | Bottom-upa | 1999–2001 | Pa | Pr | 76,4 |
Stafylas 2016 [38] | Greece | 307 | Prevalent | Top-downa | 2009–2011 | P | Pr | 66 |
Lee 2016 [31] | South Korea | 475,019 | Prevalent | Top-down | 2014 | P / S | R | – |
Murphy 2016 [27] | Ireland | 1292 | Mixeda | Mixeda | 2013 | Pa | R | 74,5 |
Ogah 2014 [32] | Nigeria | 239 | Prevalent | Mixeda | 2009–2010 | S | Pr | 58 |
Study | Main data sources | Definition of HF |
---|---|---|
Voigt, 2014 [35] | Agency for Healthcare Research and Quality (AHRQ) National Association for Home Care & Hospice (NAHC) National Ambulatory Medical Care Survey (NAMCS) National Hospital Ambulatory Medical Care Survey (NHAMCS) Centers for Medicare & Medicaid Services (CMS) | ICD-9 (428.x, 402.01, 402.11, 402.91, 398.91, 404.01, 404.11, 404.91, 416.9, 425.4, 518.4, 786) |
Corrao, 2014 [33] | Italian National Health System (NHS) database from Lombardy | ICD-9 (428, 402.01, 402.11, 402.91) |
Czech, 2013 [36] | Medical data from randomly selected outpatient units and inpatient facilities linked with patient interview data (POLKARD study) | – |
Delgado, 2013 | Medical records from specialized cardiology clinics, questionnaires and interviews (patients and caregivers) | Symptomatic patients (NYHA II-IV) with a diagnosis of HF at least 6 months previously |
Dunlay, 2011 [34] | Medical records and billing data from Olmsted County Healthcare Expenditure and Utilization Database (OCHEUD), a population-based database in Olmsted County, Minnesota, USA | ICD-9 (428) |
Bogner, 2010 [24] | Administrative database of a large urban academic health care system Medicare claims database | ICD-9 (428.0, 428.1, 428.9, 402.01, 402.11, 402.91) |
Zugck, 2010 [30] | Database of the public health insurance, cohort selected by randomly prescribed date of birth Federal Office of Statistics, Germany | ICD-10 (I50) |
Neumann, 2009 [29] | Federal Office of Statistics, Germany | ICD-10 (I50) |
Liao, 2007 [23] Liao, 2006 [25] | Cardiovascular Health Study (prospective, community-based, observational study) Medicare linked files | Hospitalization for HF or self-report of a physician diagnosis of HF |
Agvall, 2005 [28] | Hospital records from two healthcare centers Swedish National Medical Agency price list | ICD-10 (I50) |
Ory, 2005 [26] | Longitudinal database of Prescription Solutions, a pharmacy benefit and medical management organization | ICD-9 (398.91, 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.91) |
Stafylas, 2016 | EURObservational Research Programme: The Heart Failure Pilot Survey (ESC-HF Pilot) EOPYY- Greek National Organization for Health Care Provision | Hospitalization for HF or HF diagnosis according to clinical judgement of the responsible cardiologist |
Lee, 2016 [31] | Claims data from the National Health Insurance (NHI) Claims data from Medical Aid (MA) | ICD-10 (I11.0, I13.0, I13.2, I50.x) |
Murphy, 2016 | National Casemix Program, patient interviews, hospital records | ICD-10 |
Ogah, 2014 [32] | Abeokuta HF registry (hospital registry), patient interviews | ICD-10 |
Epidemiological data
Cost components
Cost components of the prevalence-based approach
Cost components | (37) | (29) | (36) | (35) | (28) | (23) | (24) | (30) | (38) | (31) | (32) | (27) | (34) | (33) | (26) | (25) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Direct costs | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
Inpatient care | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |
Medication | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||
Laboratory | ✓ | ✓ | ✓ | |||||||||||||
Physicians | ✓ | ✓ | ||||||||||||||
Intensive care units | ✓ | ✓ | ||||||||||||||
Nursing home | ✓ | ✓ | ✓ | ✓ | ||||||||||||
Outpatient care | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |
Hospital Outpatient care | ✓ | ✓ | ✓ | |||||||||||||
Physicians | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||
Specialist | ✓ | |||||||||||||||
Home care | ✓ | ✓ | ||||||||||||||
Medication | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||
Laboratory /Procedures | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||||
Paramedical staff | ✓ | ✓ | ✓ | |||||||||||||
Medical transport | ✓ | ✓ | ✓ | ✓ | ||||||||||||
Indirect costs | ✓ | ✓ | ✓ | |||||||||||||
Informal care costs | ✓ | ✓ |
Cost components of the incidence-based group
Cost estimates
Reference | Year of cost data | Country | Reported annual costs in local currency (costs per patient) | Local currency in 2016 | $US (2016 PPP) | % of inpatient costs of all direct costs | Expenditure on health, per capita, US$ (2016 PPP) |
---|---|---|---|---|---|---|---|
Voigt, 2014 [35] | 2012 | USA | $60.2 - $115.4ba(direct costs) $70.8 - $127.0ba(total costs) | $62.9 - $120.7ba $74.0 - $133.0ba | 62.9–120.7ba 74.0–133.0ba | 66 | 9892 |
Czech, 2013 [36] | 2010 | Poland | 7739 PLN | 8312 PLN | 4755 | 92e | 1798 |
Delgado, 2013 | 2010 | Spain | 4860€ (healthcare costs) | 5166€ | 7792 | 58e | 3248 |
Bogner, 2010 [24] | 2009 | USA | 22,230$b | 24,873$b | 24,873b | 84 | 9892 |
Zugck, 2010 [30] | 2002 | Germany | 11,794–16,303 €c | 14,297–19,762 €c | 18,472–25,532c | 72 | 5551 |
Neumann, 2009 [29] | 2006 | Germany | 2.879b €a | 3.293b €a | 4.255ba | 60 | 5551 |
Liao, 2007 [23] | 2006 | USA | $10,832 | 12,907$ | 12,907 | 65e | 9892 |
Agvall, 2005 [28] | 2000 | Sweden | 37,060 SEK | 44,971 SEK | 5044 | 47 | 5488 |
Stafylas, 2016 | 2014 | Greece | 4411 € | 4295 € | 7053 | 73e | 2223 |
Ogah, 2014 [32] | 2010 | Nigeria | 2128$ | 2343$ | 2343 | 44 | NA |
Lee, 2016 [31] | 2016 | South Korea | 868$ (perspective of third-party-payer) 1414$ (perspective of society) | 868$ 1414$ | 868 1414 | 53 | NA |
Dunlay, 2011 [34] | 2007 | USA | 109.541$ (lifetime costs from HF diagnosis until death) | 126.819$ | 126.819 | 77 | 9892 |
Corrao, 2014 [33] | 2011 | Italy | 11,100 € | 11,597 € | 15,952 | 92e | 3391 |
Liao, 2006 [25] | 2000 | USA | 32,580–33,023$ (prevalent group)d 45,604–49,128$ (incident group)d | 45,406–46,023$d 63,557–68,468$d | 45,406–46,023d 63,557–68,468d | 65–67 70–72 | 9892 |
Ory, 2005 [26] | 2000 | USA | 14,465$ (prevalent group) 17,744$ (incident group) | 20,159$ 24,729$ | 20,159 24,729 | NA | 9892 |
Murphy, 2016 | 2013 | Ireland | 12,206 € (patients with preserved EF) 13,011 € (patients with reduced EF) | 12,194 € 12,999 € | 15,334 16,330 | 92e 96e | 5528 |
Predictors of increasing costs
Reference | Predictors of increasing costs (x times higher costs) |
---|---|
Stafylas, 2016 | • NYHA stage • Kidney dysfunction |
Lee, 2016 [31] | • Age > = 65 (1.6) • Number of hospitalizations (9.7 for one hospitalization) |
Bogner, 2010 [24] | • Diabetes mellitus (0.4) |
Dunlay, 2011 [34] | • Diabetes mellitus (0.25) • Ejection fraction > = 50 (0.24) |
Liao, 2006 [25] | • NYHA stage (NYHA 4–0.77, NYHA 3–0.12) • Kidney dysfunction (creatinine > = 1.4 mg/dl – 0.48) • Coronary artery disease (0.32) • COPD (0.38) • Hypertension (0.27) |
Liao, 2007 [23] | • NYHA stage (NYHA 3/4–0.41) • Coronary artery disease (0.66) • Kidney dysfunction (0.13) • COPD (0.44) |
Delgado, 2013 | • NYHA stage (NYHA 3/4: 0.6–0.8 times higher costs than NYHA 2) |
Reference | Year of cost data | Country | NYHA I | NYHA II | NYHA III | NYHA IV | Total costs per patient and year |
---|---|---|---|---|---|---|---|
local currency in year of costs/ local currency in 2016/ $US in 2016, PPP | |||||||
Delgado, 2013 (direct costs) | 2010 | Spain | – | 3789€/ 4028€/ 6075$ | 6832€/ 7262€/ 10,953$ | 4860€/ 5166€/ 7792$ | |
Delgado, 2013 (total costs) | 2010 | Spain | – | 10,283–14,459€/ 10,931–15,370€/ 16,487–23,183$ | 18,265–23,721€/ 19,416–25,215€/ 29,285–38,032$ | 12,995–18,220€/ 13,814–19,368€/ 20,836–29,213$ | |
Czech, 2013 [36] | 2010 | Poland | a | 5,315PLN/ 5,708PLN/ 3265$ | 8,116PLN/ 8,717PLN/ 4987$ | 21,273PLN/ 22,847PLN/ 13,070$ | 7739PLN/ 8312PLN/ 4755$ |
Distribution of costs
Reference | Year of costs | Country | Year prior to HF diagnosis | Year beginning with HF diagnosis | Difference in costs (local currency in year of costs) | Difference in costs (local currency in 2016) | Difference in costs ($US in 2016, PPP) | Raise of the costs in % |
---|---|---|---|---|---|---|---|---|
Dunlay, 2011 [34] | 2007 | USA | 8219$ | 34,372$ | 26,153$ | 30,278$ | 30,278 | 318 |
Liao, 2006 [23] | 2000 | USA | 6650–6752$ | 24,882–25,503$ | 18,232–18,751$ | 25,409–26,133$ | 25,409–26,133 | 274–278 |