Real-World Economic and Clinical Burden of Worsening Heart Failure in the US: Administrative Claims Database Analysis
Author(s)
Benjamin Lewing, PhD, Shivanshu Awasthi, PhD, Saba Gidey, PharmD, Hong Xiao, PhD;
Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
Presentation Documents
OBJECTIVES: Worsening heart failure (WHF) represents a significant health decline in chronic HF patients, characterized by escalating symptoms and frequent rehospitalizations. An estimated, 2.5 million WHF episodes occur annually in the United States. Despite advances in HF management, WHF remains associated with significant clinical challenges and complex care needs. Understanding the clinical burden and unmet needs in this population is essential. This study describes healthcare resource utilization (HCRU) and costs among patients with WHF.
METHODS: This retrospective study utilized Merative MarketScan commercial and Medicare claims database (2021-2023). Patients with WHF, defined as hospitalization with heart failure (primary diagnosis), with a HF diagnosis recorded between 3 and 24 months before the hospitalization through the identification period (01/2021-06/2022) were included. Date of first Hospitalization during the identification period was defined as index date and patients were required to have at least three-month pre and one-year post-index continuous enrollment. Descriptive statistics summarized HCRU and costs, and time to rehospitalization was analyzed using Kaplan-Meier.
RESULTS: This study included 5,263 patients with WHF with mean(SD) age of 72.4(13.7) years and Charlson Comorbidity Index score of 5.4(4.8). Rehospitalization rates within one- and three-month post index were 12.4% and 25.5%, respectively. The overall annualized rehospitalization rate was 57.9% with an estimated median time to rehospitalization of 268 days (95% CI: 257-283). During the one-year post-index period, patients had on average 62.5 outpatient visits, while 54.8% had at least one emergency visit. Annualized average total per-person healthcare expenditure post-discharge was $86,065 including $37,828 in inpatient costs.
CONCLUSIONS: The study findings highlight the substantial health burden faced by patients with WHF, with high rates of re-hospitalization and emergency visits, driving substantial HCRU and costs for the healthcare system. These findings underscore the urgent need for effective interventions, including innovative treatments and care management strategies to address unmet needs in patients with WHF.
METHODS: This retrospective study utilized Merative MarketScan commercial and Medicare claims database (2021-2023). Patients with WHF, defined as hospitalization with heart failure (primary diagnosis), with a HF diagnosis recorded between 3 and 24 months before the hospitalization through the identification period (01/2021-06/2022) were included. Date of first Hospitalization during the identification period was defined as index date and patients were required to have at least three-month pre and one-year post-index continuous enrollment. Descriptive statistics summarized HCRU and costs, and time to rehospitalization was analyzed using Kaplan-Meier.
RESULTS: This study included 5,263 patients with WHF with mean(SD) age of 72.4(13.7) years and Charlson Comorbidity Index score of 5.4(4.8). Rehospitalization rates within one- and three-month post index were 12.4% and 25.5%, respectively. The overall annualized rehospitalization rate was 57.9% with an estimated median time to rehospitalization of 268 days (95% CI: 257-283). During the one-year post-index period, patients had on average 62.5 outpatient visits, while 54.8% had at least one emergency visit. Annualized average total per-person healthcare expenditure post-discharge was $86,065 including $37,828 in inpatient costs.
CONCLUSIONS: The study findings highlight the substantial health burden faced by patients with WHF, with high rates of re-hospitalization and emergency visits, driving substantial HCRU and costs for the healthcare system. These findings underscore the urgent need for effective interventions, including innovative treatments and care management strategies to address unmet needs in patients with WHF.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE11
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)