title: Understanding the economic burden of heart failure in China: impact on disease management and resource utilization.
abstract: OBJECTIVE
  This study has two objectives: (1) to examine healthcare resource utilization in heart failure (HF) patients; and (2) to examine the treatment costs associated with HF in China.
  
  
  METHODS
  The data used in this study was from the 2014 national insurance database sponsored by the China Health Insurance Research Association (CHIRA), that covers national urban employees and residents. ICD-10 codes and keywords indicating heart failure diagnoses were used to identify patients with heart failure. Drug utilization, hospital visits, re-admission, and treatment costs in different service categories were examined.
  
  
  RESULTS
  A total of 7,847 patients were included in this analysis, of which 1,157 patients had a 1-year complete follow-up period. In total, 48.16% of patients received the combination treatment of angiotensin-converting-enzyme inhibitor (ACEI)/angiotensin II receptor blockers (ARB) and beta-blockers (BB); and 22.87% of patients received the combination treatment of ACEI/ARB, beta-blockers and Mineralocorticoid receptor antagonists (MRAs). The annual treatment cost per patient with HF diagnosis was RMB 28,974, of which 66% was for inpatient care. The cost on HF medications accounted for 8.2% of annual cost. Treatment cost was much higher in provincial-level municipalities than that of prefecture-level and other cities.
  
  
  CONCLUSIONS
  Hospitalization is a major driver of HF treatment cost. Compared to the requirements in international treatment guidelines, HF standard of care medication treatment was under-utilized among HF patients in China. The high re-admission rate among Chinese patients indicates that the management of HF needs to be improved. The percentage of GDP spent on treating HF patients was much lower than that in the developed countries.
authors.affiliation: a The First Affiliated Hospital of Nanjing Medical University , Nanjing , PR China.
authors.forename: Jun
authors.initials: J
authors.lastname: Huang
authors.affiliation: b Centennial Scientific Co. Ltd. , Warren , NJ , USA.
authors.forename: Hongjun
authors.initials: H
authors.lastname: Yin
authors.affiliation: c Novartis Pharmaceuticals (China) , Beijing , PR China.
authors.forename: Milun
authors.initials: M
authors.lastname: Zhang
authors.affiliation: c Novartis Pharmaceuticals (China) , Beijing , PR China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Ni
authors.affiliation: d Health Economics Research Institute, Sun Yat-sen University , Guagzhou, PR China.
authors.forename: Jianwei
authors.initials: J
authors.lastname: Xuan
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000191:economics* / Q000627:therapeutic use; D002681:China; D004363:Drug Utilization / Q000191:economics; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000191:economics* / Q000628:therapy; D017722:Hospital Charges / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics; D012737:Sex Factors
chemical_list: D002317:Cardiovascular Agents
keywords: China; Heart failure; burden; cost; healthcare utilization