Characterising the Economic Burden Associated With Obstructive Hypertrophic Cardiomyopathy: Healthcare Resource Use and Costs in England

OBJECTIVES: Obstructive hypertrophic cardiomyopathy (HCM) is associated with high disease burden, including an increased risk of complications such as arrhythmias and heart failure. This is likely to result in high healthcare resource use (HCRU) and consequent costs. This study aimed to characterise the economic burden associated with obstructive HCM in England.

METHODS: This retrospective study used electronic health records from the primary care Clinical Practice Research Datalink (CPRD) GOLD and Aurum datasets linked to secondary care Hospital Episode Statistics (HES) databases in England. Patients were aged ≥18 years at index date (diagnosis of obstructive HCM between April 2009 and October 2020) with ≥1 year of follow-up. HCRU was captured from activity counts for primary and secondary care services with costs obtained from the National Schedule of NHS costs annual report (2019-20), adjusted to 2021 costs. HCRU and costs were estimated per patient-year (PPY) and stratified by severity measured by New York Heart Association (NYHA) class. NYHA class was assigned using an algorithm based on prescriptions and symptoms.

RESULTS: A total of 3,730 patients met eligibility criteria, contributing 19,352 patient-years. At baseline, 26%, 34%, 38% and 3% were NYHA class I-IV, respectively, while at end of follow-up this distribution was 6%, 47%, 44% and 4%. Total HRU costs irrespective of NYHA were £3,893 PPY with the majority (£2,071 PPY) from secondary inpatient care. PPY costs increased with higher (worse) NYHA class, from £2,747 (NYHA class I) to £6,990 (NYHA class IV). For patients in NYHA class II-IV, non-elective care was the primary driver of inpatient costs, whereas, elective care for NYHA class I patients.

CONCLUSIONS: HCRU and costs increased with higher (worse) NYHA class across primary and secondary care. These data indicate that the health economic burden of obstructive HCM in England is considerable, particularly in patients with more severe disease.