Medical resource use and expenditure in patients with chronic heart failure: a population-based analysis of 88 195 patients.
Heart failure (HF) is one of the diseases with greater healthcare expenditure. However, little is known about the cost of HF at a population level. Hence, our aim was to study the population-level distribution and predictors of healthcare expenditure in patients with HF.



This was a population-based longitudinal study including all prevalent HF cases in Catalonia (Spain) on 31 December 2012 (n = 88 195). We evaluated 1-year healthcare resource use and expenditure using the Health Department (CatSalut) surveillance system that collects detailed information on healthcare usage for the entire population. Mean age was 77.4 (12) years; 55% were women. One-year mortality rate was 14%. All-cause emergency department visits and unplanned hospitalizations were required at least once in 53.4% and 30.8% of patients, respectively. During 2013, a total of €536.2 million were spent in the care of HF patients (7.1% of the total healthcare budget). The main source of expenditure was hospitalization (39% of the total) whereas outpatient care represented 20% of the total expenditure. In the general population, outpatient care and hospitalization were the main expenses. In multivariate analysis, younger age, higher presence of co-morbidities, and a recent HF or all-cause hospitalization were independently associated with higher healthcare expenditure.



In Catalonia, a large portion of the annual healthcare budget is devoted to HF patients. Unplanned hospitalization represents the main source of healthcare-related expenditure. The knowledge of how expenditure is distributed in a non-selected HF population might allow health providers to plan the distribution of resources in patients with HF.
Heart Failure Programme, Department of Cardiology, Hospital del Mar, Barcelona, Spain.|Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Nuria
N
Farré
Analysis on Demand and Activity Division, Catalan Health Service, Barcelona, Spain.
Emili
E
Vela
Analysis on Demand and Activity Division, Catalan Health Service, Barcelona, Spain.
Montse
M
Clèries
Analysis on Demand and Activity Division, Catalan Health Service, Barcelona, Spain.
Montse
M
Bustins
Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.|Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Miguel
M
Cainzos-Achirica
Heart Failure Programme, Department of Cardiology, Hospital del Mar, Barcelona, Spain.|Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.|School of Medicine, Universitat Pompeu Fabra and Universitat Autònoma de Barcelona, Spain.
Cristina
C
Enjuanes
Heart Failure Programme, Department of Cardiology, Hospital del Mar, Barcelona, Spain.|Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.|School of Medicine, Universitat Pompeu Fabra and Universitat Autònoma de Barcelona, Spain.
Pedro
P
Moliner
Heart Failure Programme, Department of Cardiology, Hospital del Mar, Barcelona, Spain.|Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Sonia
S
Ruiz
Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.|School of Medicine, Universitat Pompeu Fabra and Universitat Autònoma de Barcelona, Spain.|Jordi Gol Primary Care Research Institute, Catalan Institute of Heath, Barcelona, Spain.
Jose Maria
JM
Verdú-Rotellar
Heart Failure Programme, Department of Cardiology, Hospital del Mar, Barcelona, Spain.|Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.|School of Medicine, Universitat Pompeu Fabra and Universitat Autònoma de Barcelona, Spain.
Josep
J
Comín-Colet
D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D002908:Chronic Disease; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000191:economics / Q000453:epidemiology*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015995:Prevalence; D013030:Spain / Q000453:epidemiology
Cost; Expenditure; Heart failure; Hospitalization; Resource utilization