title: The cost of inpatient management of heart failure patients: a microcosting study in the Irish healthcare setting.
abstract: OBJECTIVE
  To formally assess the resource use and cost of the inpatient treatment of heart failure (HF) from the health-payer's perspective. In addition, to compare costs in our cohort to (a) locally derived patient-level costs (PLC) and (b) national costs as per disease-related group (DRG).
  
  
  RESULTS
  Study population Demographics and resource utilisation data were obtained from a cohort of 30 patients (57% male, mean age 70 years) admitted into a single tertiary centre with heart failure. Patients were identified retrospectively. Costing A microcosting approach was used to examine admission costs that were compared to PLC costs and DRG costs. Main outcome measure The bootstrap estimation was used to determine mean inpatient length of stay (LOS) with standard deviation (±SD) and mean costs ±SD.
  
  
  RESULTS
  The bootstrapped mean cost per HF episode was €10,474 ± 2478. The major cost drivers were ward stay (mean cost €6068 ± €1681): laboratory costs (€1373 ± 79) and cath lab costs (€1415 ± 729). HF was more expensive to manage in patients ≤65 years (€18,930 ± 5546) compared to those aged over 65 years (€6209 ± 1732); p = 0.001. No significant difference was found in managing heart failure in males (€11,035 ± 3564) versus females (€9629 ± 3294), p = 0.69. DRG costing frequently over or underestimated the admission cost. PLC costs were similar to microcosting derived costs. The bootstrapped mean LOS per HF episode was 15.7 days ± 3.4.
  
  
  CONCLUSIONS
  This study confirms that heart failure is a costly condition and that inpatient stay is the major cost driver. HF was significantly more expensive to manage in patients ≤65 years compared to those aged over 65 years. DRG costing frequently over or underestimated the admission cost. Patient-level costs and microcosting are more accurate methods of costing inpatient HF admissions. To our knowledge, this is the first study of the cost of the inpatient treatment of HF within the context of the Irish healthcare setting.
authors.affiliation: St James's Hospital, Dublin 8, Ireland. morganro@tcd.ie.|Brigham and Women's Hospital, Boston, MA, 02115, USA. morganro@tcd.ie.
authors.forename: R B
authors.initials: RB
authors.lastname: Morgan
authors.affiliation: Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, USA.
authors.forename: L
authors.initials: L
authors.lastname: McCullagh
authors.affiliation: Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, USA.|National Centre for Pharmacoeconomics, St James's Hospital, Dublin 8, USA.
authors.forename: M
authors.initials: M
authors.lastname: Barry
authors.affiliation: St James's Hospital, Dublin 8, Ireland.|Department of Cardiology, Trinity College Dublin, Dublin, USA.
authors.forename: C
authors.initials: C
authors.lastname: Daly
mesh_terms: D000368:Aged; D015331:Cohort Studies; D017281:Cost of Illness; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D006333:Heart Failure / Q000191:economics / Q000628:therapy*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics; D008297:Male; D012189:Retrospective Studies
keywords: Cost; Disease modifying programme; Economic; Heart failure; Pharmacoeconomic