Abstract
Aims
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).
Methods and 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.
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Acknowledgements
Roisin Adams, National Centre for Pharmacoeconomics, St James’s Hospital, Dublin 8. Roisin was involved in pharmacoeconomic assessment advice and microcosting advice throughout the duration of the research. Ciara Mahon, MB BCH BAO, St James’s Hospital, Dublin 8 Ireland. Ciara was involved in data collection and entry during the initial stages of the research. Nicola Ryan, MB BCH BAO, St James’s Hospital, Dublin 8 Ireland. Nicola was involved in data collection and entry during the latter stages of the research. Guarantor: Caroline Daly MD, Ph.D., FRCPI, St James’s Hospital, Dublin 8, Ireland. Roisin Morgan (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
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Funding
Roisin Morgan received salary support from the St James’s Hospital Cardiac Research Fund during this research (2011–2013).
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All authors declared that they have no conflict of interest.
Ethical approval for the study was sought from St James’s Hospital research ethics committee and deemed unnecessary due to the retrospective nature of the data collection and analysis and no direct patient contact required.
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Morgan, R.B., McCullagh, L., Barry, M. et al. The cost of inpatient management of heart failure patients: a microcosting study in the Irish healthcare setting. Ir J Med Sci 186, 293–303 (2017). https://doi.org/10.1007/s11845-016-1514-7
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DOI: https://doi.org/10.1007/s11845-016-1514-7