HF ‘most expensive’ comorbidity, exceeding $22 billion per year
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An additional $22.3 billion is spent nationally on HF-related medical services each year, with the total annual expenditure for adults with HF approaching $180 billion, according to an analysis of Medical Expenditure Panel Survey data.
In the analysis, researchers found that expenditures for patients with HF in the U.S. increased from 2009 to 2018, with roughly $3,594 per year attributable to HF. Additionally, the average annual expenditure for a patient with HF was $28,950, or roughly fivefold higher than that of patients without HF.
“Together, these findings suggest that expenditure for a patient with HF reflects diagnosis and treatment for a variety of comorbidities present in this population,” Boback Ziaeian, MD, PhD, FACC, clinical instructor in the division of cardiology at David Geffen School of Medicine at UCLA and a clinical instructor in the division of cardiology at VA Greater Los Angeles Healthcare System, and colleagues wrote. ‘Notably, among the comorbidities included, HF was the most expensive.”
Ziaeian and colleagues analyzed pooled Medical Expenditure Panel Survey (MEPS) data from 2009 to 2018, including 250,820 participants, to calculate total HF-related expenditures across clinical settings in the United States. The researchers used a two-part model adjusted for demographics, comorbidities and year to estimate annual mean and incremental expenditures associated with HF. They defined total medical expenditure as the sum of direct payments for care across medical service lines, including inpatient hospitalization stays, outpatient and office-based visits, prescription medication, ED visits, dental visits, home health care and others. Payments were combined across payers, including Medicare, Medicaid, Tricare and private insurance; out-of-pocket expenditure; and others. Expenditure and income data were converted to 2018 inflation-adjusted dollars using the consumer price index.
Using 2018 inflation-adjusted dollars, an average of $28,950 was spent per year in the U.S. for health care-related expenditure for people with HF compared with $5,727 for those without HF, a nearly fivefold difference, according to the researchers.
After adjusting for demographics and comorbidities, a diagnosis of HF was associated with $3,594 in annual incremental expenditure compared with those without HF. Additionally, HF-related expenditures increased from $26,864 annually per person in 2009-2010 to $32,955 in 2017-2018, representing a 23% rise over 10 years.
In comparison, expenditure on MI, type 2 diabetes and cancer grew by 16%, 28% and 16%, respectively.
Most of the HF-related cost was related to hospitalization: $12,569 per year.
Outpatient office-based care and prescription medications accounted for the greatest growth in cost during the period, 41% and 24%, respectively.
The estimated incremental national expenditure for expenses attributable to HF per year was $22.3 billion; the total annual expenditure for adults with HF was $179.5 billion.
“The economic burden of HF in the United States from 2009-2018 continues to increase,” the researchers wrote. “We find that nationally, an additional $22.3 billion is spent to provide HF-related medical services.”
The researchers wrote that further research may characterize the “nuanced relationship” between health care utilization and expenditure, particularly as it varies by health care service line or payer type.
“A better understanding of the drivers of HF expenditure can help optimize programs and policies to control spending,” the researchers wrote. “The rapidly rising burden of HF on aging individuals in the United States and its financial toll on the nation necessitate a shift toward effective prevention strategies and higher-value care for this population.”
Perspective
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Harlan M. Krumholz, MD, SM
This useful and rigorous analysis puts the economic toll of HF in perspective. With this size cost of care related to HF, society has ample incentive to invest heavily in the prevention of HF as a national priority and for cost-effective solutions to mitigate the risk and suffering of those who already have it.
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