Treatment charges and resource use among patients with heart failure enrolled in an MCO.
The purpose of this study was to determine patient-level annual expenditures and resource use for heart failure (HF) and change in annual expenditure after a hospital admission for HF. The study population comprised members of an IPA-model MCO (N = 899) who were 40 to 74 years old and continuously enrolled for at least six months before and after an index hospital admission with a primary diagnosis of HF. A retrospective analysis was conducted of administrative claims data between 1996 and 1998. Analysis was stratified by five-year age groups and by quintiles created by rank-ordering individuals according to their pre-index annualized expenditure and then dividing the cohort into five equal groups. During the year before the index HF event, median annualized charges were $6,026 (mean +/- SD, $17,490 +/- $32,234), and median postevent charges were $14,292 (mean, $35,780 +/- $60,881), a 98% increase in median (105% increase in mean). Age was unrelated to average annual expenditure or to increase in expenditure after the index event. One-year readmission rates ranged from 30% (95% confidence interval [CI], 35%-51%), for patients in the least costly quintile, to 63% for the most costly quintile (95% CI, 55%-71%). Although HF prevalence increases with age, patient-level treatment expenditures are comparable across age groups. Hospital admission for HF is associated with a substantial increase in treatment intensity and annual expenditure.
de Lissovoy
Gregory
G
MEDTAP International, Bethesda, Maryland, USA.
Zodet
Marc
M
Coyne
Karen
K
O'Connell
John B
JB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017281:Cost of Illness; D011307:Drug Prescriptions; D018588:Fee-for-Service Plans; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data; D006333:Heart Failure / Q000145:classification / Q000191:economics*; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D007193:Independent Practice Associations / Q000191:economics* / Q000706:statistics & numerical data; D007345:Insurance Claim Review; D008875:Middle Aged; D011787:Quality of Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States