Abstract 2380: Cost of Inpatient Care for Medicare Heart Failure Patients, 2001–2004:More Than Just Heart Failure
Background: The primary driver of cost for heart failure (HF) patients is inpatient care. It is unclear whether recent advances in the care of HF have translated into changes in the cost to Medicare of inpatient HF care.
Method: From CMS, we obtained inpatient claims and the corresponding denominator files for all elderly Medicare beneficiaries with a primary diagnosis of HF on a single inpatient claim and discharged alive. We considered the earliest HF hospitalization after January 1, 2001, to be the index event, and calculated total, cardiovascular (CV), and HF 1-year inpatient costs to Medicare. We adjusted all costs to year 2001 dollars. To examine the adjusted relationship between covariates and total costs, we used generalized linear models with a log link and with adjustment for clustering of similar patients within hospitals.
Results: From January 1, 2001, to December 31, 2004, 1,363,977 Medicare beneficiaries patients (mean age 80 years, 58.3% female) had an index HF hospitalization. Of this cohort, 901,885 (66%) had a subsequent inpatient claim within the following year. Total, CV and HF inpatients costs are shown on Table 1⇓. There were no significant changes over time. Significant predictors of 1-year inpatient costs in order of strength of association included inpatient costs in the prior year, Northeast location, not having metastatic cancer or dementia, renal failure, valvular disease, black race, and diabetes.
Conclusion: The cost of inpatient care for HF patients is high, but the majority of costs are for non-CV and non-HF care. The lack of change over the four years of this study and the majority of costs being driven by non-CV and non-HF costs suggests that strategies and therapies focusing only on HF care may be misdirected. Further research is needed to evaluate the use of potential predictors of cost to risk stratify patients for chronic care and to evaluate strategies that target primary cost drivers for HF patients.