OBJECTIVES: To estimate direct, lost productivity and out-of-pocket costs attributable to heart failure (HF) and worsening heart failure with reduced ejection fraction (HFrEF) in Colombia.

METHODS: We initially performed an epidemiological estimation of cases and mortality based on local data and published literature. We quantified patients in each ejection fraction (EF) stage, focusing on worsening HFrEF. For the direct costs, we estimated annual costs using base case with experts differentiating resource consumption depending on EF. Costing was performed using local tariff manuals. For productivity loss, we considered local income and employment figures to estimate active population. For productivity lost due to morbidity, we considered time lost due to medical needs considering the quantity of consultation and hospitalizations required. For productivity lost due to premature mortality, we considered life expectancy and income, including a 5% discount rate. For out-of-pocket expense, we considered co-payments and transportation. (2020, 1 USD = $3,693.36 COP)

RESULTS: We estimated a total of 490,831 total HF cases, with 27,437 deaths. Of these, 76,247 (16%) cases and 13,308 (49%) deaths were related to worsening HFrEF. We estimated 1.2 billion USD in total costs (46% due to worsening HFrEF). Direct costs were 741 million USD for HF and 331 million USD for worsening HFrEF (44.7%). Lost productivity costs were 467 million USD for HF and 228 million USD for worsening HFrEF (48.5%). We estimated 7 million USD for HF, of which 1.1 million (15.5%) were attributed to worsening HFrEF,

CONCLUSIONS: We estimated significant costs related to HF. Worsening HFrEF was related to just 16% of cases but produced a much more significant fraction of total costs, direct costs, lost productivity costs. This is related to the significant morbidity and mortality present in those patients.