Abstract 3231: Resource Use and Costs of Heart Failure in Medicare Population, 2003–2005
Introduction: Recent analyses suggest incidence of heart failure (HF) has declined among the elderly during the past decade. However, estimation of resource use and costs for HF management has not been well characterized. This study sought to examine the economic burden for patients with newly diagnosed HF during a 3-year period.
Methods: The Medicare Standard Analytic File (SAF), a 5% national sample, was used in this retrospective analysis to identify patients with a primary HF diagnosis (ICD-9-CM 428.xx) from Jan to Mar 2003. Patients with prior HF diagnoses in 2002 were excluded. The identified patients were followed for three years through Dec 2005. Their Medicare claims were linked from different care settings to examine the characteristics of these patients, as well as the total and HF-related resource use and costs.
Results: Of the 1.7 million patients in SAF, 30,386 patients were newly diagnosed with HF from Jan to Mar 2003 (18 per 1,000). Mean age was 77; 41% of the sample were male, and 84% were Caucasian. Among these patients, 76% had at least one comorbid disease in the 12 months before HF diagnosis. The 1- and 2-year mortality rates were 22% and 36%, respectively. These newly diagnosed HF patients cost Medicare $22,775, $16,026, and $17,050 on average from 2003 to 2005, respectively, compared to $5,828, $7,012, and $7,564 for the general Medicare population. HF-related services constituted a significant portion of the total costs, accounting for 38%, 49% and 54% from 2003 to 2005. HF-related inpatient hospitalizations most likely resulted in reimbursement with DRG 127, followed by DRG 124, and DRG 115. Oxygen concentrator use, skilled nursing care, and subsequent hospital care represented the highest cost components for HF-related outpatient services. These data translated into an estimated direct cost of $14 billion to the Medicare system, $5.2 billion of which were attributable to HF in 2003 alone.
Conclusions: HF is associated with significant burden to Medicare. The high Medicare cost of HF patients will be a growing concern as the Medicare population grows. Optimal strategies for the prevention, treatment and management of this chronic disease will need to be identified.