title: The healthcare costs of heart failure during the last five years of life: A retrospective cohort study.
abstract: BACKGROUND
  Evidence on the economic impact of heart failure (HF) is vital in order to predict the cost-effectiveness of novel interventions. We estimate the health system costs of HF during the last five years of life.
  
  
  METHODS
  We used linked primary care and mortality data accessed through the Clinical Practice Research Datalink (CPRD) to identify 1555 adults in England who died with HF in 2012/13. We used CPRD and linked Hospital Episode Statistics to estimate the cost of medications, primary and hospital healthcare. Using GLS regression we estimated the relationship between costs, HF diagnosis, proximity to death and patient characteristics.
  
  
  RESULTS
  In the last 3months of life, healthcare costs were £8827 (95% CI £8357 to £9296) per patient, more than 90% of which were for inpatient or critical care. In the last 3months, patients spent on average 17.8 (95% CI 16.8 to 18.8) days in hospital and had 8.8 (95% CI 8.4 to 9.1) primary care consultations. Most (931/1555; 59.9%) patients were in hospital on the day of death. Mean quarterly healthcare costs in quarters after HF diagnosis were higher (£1439; [95% CI £1260 to £1619]) than in quarters preceding diagnosis. Older patients and patients with lower comorbidity scores had lower costs.
  
  
  CONCLUSIONS
  Healthcare costs increase sharply at the end of life and are dominated by hospital care. There is potential to save money by implementation and evaluation of interventions that are known to reduce hospitalisations for HF, particularly at the end of life.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK. Electronic address: William.hollingworth@bristol.ac.uk.
authors.forename: William
authors.initials: W
authors.lastname: Hollingworth
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Mousumi
authors.initials: M
authors.lastname: Biswas
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Maishman
authors.affiliation: Department of Cardiology, Taunton and Somerset NHS Foundation Trust, Taunton, UK.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Dayer
authors.affiliation: King's College Hospital, London, UK.
authors.forename: Theresa
authors.initials: T
authors.lastname: McDonagh
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Purdy
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Barnaby C
authors.initials: BC
authors.lastname: Reeves
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Rogers
authors.affiliation: Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Williams
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Pufulete
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006333:Heart Failure / Q000191:economics / Q000401:mortality / Q000628:therapy; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013727:Terminal Care / Q000191:economics* / Q000379:methods; D006113:United Kingdom / Q000453:epidemiology
keywords: HF; Health care costs; Hospital costs; Terminal care