title: Predicting costs of care in heart failure patients.
abstract: BACKGROUND
  Identifying heart failure patients most likely to suffer poor outcomes is an essential part of delivering interventions to those most likely to benefit. We sought a comprehensive account of heart failure events and their cumulative economic burden by examining patient characteristics that predict increased cost or poor outcomes.
  
  
  METHODS
  We collected electronic medical data from members of a large HMO who had a heart failure diagnosis and an echocardiogram from 1999-2004, and followed them for one year. We examined the role of demographics, clinical and laboratory findings, comorbid disease and whether the heart failure was incident, as well as mortality. We used regression methods appropriate for censored cost data.
  
  
  RESULTS
  Of the 4,696 patients, 8% were incident. Several diseases were associated with significantly higher and economically relevant cost changes, including atrial fibrillation (15% higher), coronary artery disease (14% higher), chronic lung disease (29% higher), depression (36% higher), diabetes (38% higher) and hyperlipidemia (21% higher). Some factors were associated with costs in a counterintuitive fashion (i.e. lower costs in the presence of the factor) including age, ejection fraction and anemia. But anemia and ejection fraction were also associated with a higher death rate.
  
  
  CONCLUSIONS
  Close control of factors that are independently associated with higher cost or poor outcomes may be important for disease management. Analysis of costs in a disease like heart failure that has a high death rate underscores the need for economic methods to consider how mortality should best be considered in costing studies.
authors.affiliation: The Center for Health Research, Kaiser Permanente Northwest, 3800 N, Interstate Avenue, Portland, OR 97227, USA. David.h.smith@kpchr.org
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
authors.forename: Eric S
authors.initials: ES
authors.lastname: Johnson
authors.forename: David K
authors.initials: DK
authors.lastname: Blough
authors.forename: Micah L
authors.initials: ML
authors.lastname: Thorp
authors.forename: Xiuhai
authors.initials: X
authors.lastname: Yang
authors.forename: Amanda F
authors.initials: AF
authors.lastname: Petrik
authors.forename: Kathy A
authors.initials: KA
authors.lastname: Crispell
mesh_terms: D000328:Adult; D000368:Aged; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006333:Heart Failure / Q000191:economics* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015205:Northwestern United States; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult