title: Healthcare Costs Among Patients with Heart Failure: A Comparison of Costs between Matched Decedent and Survivor Cohorts.
abstract: Prior research suggests increased costs during the final months of life, yet little is known about healthcare cost differences between patients with heart failure (HF) who die or survive.
  
  
  
  A retrospective claims study from a large US health plan [commercial and Medicare Advantage with Part D (MAPD)] was conducted. Patients were ≥18 years old with two non-inpatient or one inpatient claim(s) with HF diagnosis code(s). The earliest HF claim date during 1 January 2010-31 December 2011 was the index date. Cohort assignment was based on evidence of death within 1 year (decedents) or survival for >1 year (survivors) post-index. Per-patient-per-month (PPPM) and 1-year (variable decedent follow-up) costs (all-cause and HF-related) were calculated up to 1 year post-index. Cohorts were matched on demographic and clinical characteristics. Independent samples t tests and Pearson's chi-square tests were used to examine cohort differences.
  
  
  
  Among patients with HF, 8344 survivors were 1:1 matched to decedents [mean age 75 years, 50% female, 88% MAPD; mean time to decedents' death: 150 (SD 105) days]. Compared to survivors, more decedents had no pharmacy claims for HF-related outpatient pharmacotherapy within 60 days post-index (42.1% vs. 27.1%; p < 0.001). Decedents also incurred higher all-cause medical costs (PPPM: $21,400 vs. $2663; 1 year: $60,048 vs. $32,394; both p < 0.001) and higher HF-related medical costs (PPPM: $16,477 vs. $1358; 1 year: $39,052 vs. $16,519; both p < 0.001). Hospitalizations accounted for more than half of all-cause PPPM medical costs (54.6% for survivors, 84.3% for decedents).
  
  
  
  Patients with HF who died within 1 year after an index HF encounter incurred markedly higher costs within 1 year (despite the much shorter post-index period) and PPPM costs than those who survived, with the majority of costs attributable to hospitalizations for both patient cohorts. There may be opportunities for improving outcomes in HF, considering higher use of pharmacotherapy and lower costs were seen among survivors.
authors.affiliation: Institute for Health Outcomes Policy and Economics, Rutgers University, Piscataway, NJ, USA.|Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
authors.forename: Engels N
authors.initials: EN
authors.lastname: Obi
authors.affiliation: Optum, Inc., Eden Prairie, MN, USA. jason.swindle@optum.com.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Swindle
authors.affiliation: Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Turner
authors.affiliation: Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Russo
authors.affiliation: Optum, Inc., Eden Prairie, MN, USA.
authors.forename: Aylin
authors.initials: A
authors.lastname: Altan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006333:Heart Failure / Q000191:economics*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017741:Survivors; D014481:United States; D055815:Young Adult
keywords: Administrative claims studies; Cardiology; Healthcare costs; Heart failure; Pharmacotherapy; Survivor-decedent analysis