EPIDEMIOLOGY AND ECONOMIC CONSEQUENCES OF ADVANCED HEART FAILURE IN GERMANY
Author(s)
Daniel Gensorowsky, PhD1, Jana Diekmannshemke, MSc1, Julian Witte, PhD1, Lothar Germeroth, PhD2.
1Vandage GmbH, Bielefeld, Germany, 2Repairon GmbH, Göttingen, Germany.
1Vandage GmbH, Bielefeld, Germany, 2Repairon GmbH, Göttingen, Germany.
OBJECTIVES: Advanced heart failure (AdHF) is the end stage of heart failure (HF), characterized by severe symptoms, recurrent decompensation, and poor prognosis despite guideline-directed therapy. This study assessed the epidemiology, mortality, and healthcare costs of AdHF in Germany compared with earlier-stage HF and described the burden associated with left ventricular assist device (LVAD) implantation and heart transplantation (HTX).
METHODS: This retrospective cohort study used anonymized Statutory Health Insurance claims data provided by GWQ ServicePlus AG (2010-2023). Adults aged 18-80 years with incident HF or first fulfillment of AdHF criteria between 2011 and 2022 were included. AdHF was operationalized using European Society of Cardiology (ESC) criteria and a validated claims-based algorithm requiring two hospitalizations for HF or ventricular arrhythmia within 12 months. Outcomes included mortality and cross-sector healthcare costs over one-, two-, and five-year follow-up. Additional analyses evaluated hospital and long-term costs after LVAD implantation or HTX.
RESULTS: Overall, 235,000 patients with incident HF and 16,000 with AdHF were included. Extrapolated to Germany, approximately 44,000 individuals per year newly met AdHF criteria. Mortality was markedly higher in AdHF: 31%, 43%, and 64% died within one, two, and five years, respectively, versus 11%, 15%, and 26% in incident HF. Healthcare costs per person-year were 112% higher in AdHF in year 1 and nearly 150% higher over five years; inpatient care was the main driver. Among five-year survivors, monthly costs averaged €770 in AdHF versus €340 in incident HF. LVAD implantation and HTX generated direct hospital costs of €169,000 and €162,000, respectively. One-year mortality remained high after LVAD (32%) and HTX (23%); five-year costs reached €309,000 after LVAD and €269,000 after HTX.
CONCLUSIONS: AdHF imposes substantial epidemiological and economic burden in Germany, with high incidence, excess mortality, and persistently elevated costs. Findings support earlier identification, optimized care pathways, and hospitalization-reduction strategies.
METHODS: This retrospective cohort study used anonymized Statutory Health Insurance claims data provided by GWQ ServicePlus AG (2010-2023). Adults aged 18-80 years with incident HF or first fulfillment of AdHF criteria between 2011 and 2022 were included. AdHF was operationalized using European Society of Cardiology (ESC) criteria and a validated claims-based algorithm requiring two hospitalizations for HF or ventricular arrhythmia within 12 months. Outcomes included mortality and cross-sector healthcare costs over one-, two-, and five-year follow-up. Additional analyses evaluated hospital and long-term costs after LVAD implantation or HTX.
RESULTS: Overall, 235,000 patients with incident HF and 16,000 with AdHF were included. Extrapolated to Germany, approximately 44,000 individuals per year newly met AdHF criteria. Mortality was markedly higher in AdHF: 31%, 43%, and 64% died within one, two, and five years, respectively, versus 11%, 15%, and 26% in incident HF. Healthcare costs per person-year were 112% higher in AdHF in year 1 and nearly 150% higher over five years; inpatient care was the main driver. Among five-year survivors, monthly costs averaged €770 in AdHF versus €340 in incident HF. LVAD implantation and HTX generated direct hospital costs of €169,000 and €162,000, respectively. One-year mortality remained high after LVAD (32%) and HTX (23%); five-year costs reached €309,000 after LVAD and €269,000 after HTX.
CONCLUSIONS: AdHF imposes substantial epidemiological and economic burden in Germany, with high incidence, excess mortality, and persistently elevated costs. Findings support earlier identification, optimized care pathways, and hospitalization-reduction strategies.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO99
Topic
Clinical Outcomes, Epidemiology & Public Health, Medical Technologies
Topic Subcategory
Relating Intermediate to Long-term Outcomes
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)