OBJECTIVES: This retrospective study aimed to identify the healthcare costs from secondary care (HCsc) of newly diagnosed patients with HF and characterize the cost drivers of patients with incident HF incurring the highest cost in Sweden.

METHODS: Electronic Medical Records from both primary and secondary care in the Uppsala and Västerbotten counties were used to identify adult patients with incident HF recorded between 2010 and 2012 (considering look-back period from 01/01/2005) and at least two HF diagnoses during the analysis period. Patients were followed until 31/03/2015, transfer out or death, whichever occurred first.

RESULTS: 5,205 patients were eligible. In the first year after first HF diagnosis (index), total all-cause HCsc were €12,890/patient/year. Inpatient care constituted more than 90% of total HCsc/patient at 1-year after diagnosis for all-cause (€11,805), CVD-related (€11,141) and HF-related (€8,704) events. Of the total patient population, 10% (n=520) incurred almost 40% of total HCsc. Compared with the overall population these patients were younger (70.4 vs. 76.8 years) and were more predominantly men (60.8% vs. 54%). A logistic regression using top 10% most expensive patients as dependent variable showed that factors (OR [95% CI]) with significant impact on costs included: age (reference category [rc]: 18-54 years, 75-84 years (0.39 [0.27-0.57]) and 85+ years (0.21 [0.13-0.33]); NT-proBNP levels (ng/L) (rc: 0-1000, 1001-3000 (1.48 [1.09-2.01]), >3001 (1.93 [1.45-2.57]); no ACEi/ARB treatment (rc: ACEi treatment, 1.63 [1.31-2.03]); AF (0.77 [0.61-0.97]); anemia (1.63 [1.24-2.14]); aortic regurgitation (2.54 [1.92-3.37]); dementia (0.53 [0.29-0.99]); and mitral insufficiency (2.58 [1.74-3.81]).

CONCLUSIONS: Patients newly diagnosed with HF incur high HCsc, mainly driven by inpatient costs. Factors associated with higher costs during first year were younger age, anemia, aortic regurgitation, mitral insufficiency, no ACEi/ARB treatment and higher NT-proBNP levels. Understanding the cost drivers and profile of high cost groups of patients with HF is important from both healthcare systems and payer perspective.