Abstract 2745: The Cost of Medical Management of End-Stage Heart Failure Patients in the Final Two Years of Life
PURPOSE: To analyze costs and resource utilization among end-stage heart failure (ESHF) patients treated with medical management (MM) alone.
METHODS: The study population (mean age 67.9±7.4) included patients randomized to the MM arm of the REMATCH trial. Detailed inpatient and outpatient utilization data were obtained from CMS (1/1/98–12/31/02). Of 47 patients with CMS data, patients with < 30 costing days prior to death (n=3) and those alive on 12/31/02 (n=3) were excluded. Cost and resource use were tracked from the date of death (td) backwards in 3-month intervals (td-1, td-2, etc) to the first documented charge; this included costs incurred both prior to and during the REMATCH trial. Primary analysis focused on the final 2 yrs of life; 2yr totals were determined by
summing means from each interval (calculated; n=41) and
limiting analysis to those with complete 2yr followup (uncensored; n=26)
RESULTS: The calculated mean cost of MM in the final 2 yrs of life was $161,154, with 51.5%, or $82,963, occurring in the final 6 mos. The mean quarterly cost increased 5.2x from td-8 ($8,816± $14,270) to td-1 ($45,970±$41,176). The number of inpatient days (Table 1⇓) increased 6.6x from td-8 (3.8 ± 4.7) to td-1 (25.1 ± 23.5). The uncensored mean 2-yr total cost was $201,227± $183,326 (median cost: $ 136,971), with $97,420± $91,604 (48.4%) expended in the final 6 mos (median: $71,353). Costs in the last 6 mos were higher among patients who died as inpatients ($95,332, n=24) vs outpatients ($79,513, n=8) or in hospice ($55,517, n=9).
CONCLUSIONS: Findings here suggest that, per 100,000 MM-ESHF patient-deaths, $16B-$20B in medical resources are consumed in the final 2 yrs of life, including $8.3B-$9.7B in the last 6 mos. With REMATCH demonstrating that 2-yr survival in this group is < 10%, aggressive MM alone offers limited value for expense incurred. Therefore, alternative management strategies that improve outcomes, minimize suffering, and/or reduce expenditures should be explored.