Abstract P240: End of Life Costs in Community Patients with Heart Failure
Background: Heart failure (HF) care constitutes an increasing economic burden on the healthcare system, and has become a key focus in the healthcare debate. Costs incurred at the end of life can be particularly high in some populations, however, end of life costs among a community population of HF patients have not been well delineated.
Methods: Olmsted County residents with incident HF from 1987-2006 were identified and followed until death. Direct medical costs incurred in the last 6 months prior to death were obtained using population-based administrative data through 2010. For those that died within 6 months of HF diagnosis, costs were included from diagnosis until death. Costs were inflated to 2010 U.S. dollars using the general Consumer Price Index (CPI).
Results: A total of 862 HF patients were identified, died during follow-up, and had complete cost data (mean age 79.4 years, 46.4% male, 56.5% EF≥50%). Median costs within the last 6 months of life were $12,069 per person (25th-75th percentile $1768 - $30,841, mean $24,052), with the majority accumulated during hospitalizations (median $8849 per person, mean $20,263, 84.2% total costs for population). A total of 596 (69.1%) patients were hospitalized in the last 6 months of life, and 235 (27.3%) died in the hospital. Costs progressively increased in the months prior to death (Figure), with nearly half (43.4%) of total costs in the last 6 months of life accumulated during the month before death. End of life costs did not change over the study period (p=0.154 adjusted for age and sex).
Conclusions: End of life costs are high among community HF patients, particularly in the final month of life. Most of these costs are accumulated during hospitalizations, and a large proportion of HF patients died in the hospital. Among patients with HF nearing the end of life, alternative strategies of care that avoid hospitalizations may be particularly cost-saving.
- © 2012 by American Heart Association, Inc.