OBJECTIVES: Hypertrophic cardiomyopathy (HCM) is a highly prevalent cardiomyopathy in the UK and despite this, there is a general paucity of evidence seeking to understand the relationship between disease severity (New York Heart Association [NYHA] class) and outcomes, including economic burden. An expert elicitation study was undertaken to address this evidence gap in obstructive HCM.

METHODS: One practicing cardiologist from each of 24 centres that treat patients with HCM in the UK was invited; ten cardiologists participated in the study, of which two specialised in structural interventions (i.e., septal reduction therapies). A modified Delphi methodology was applied across three phases: 1) a purpose-built survey; 2) moderated panel discussion; 3) re-assessment of initial survey responses. Experts quantified resources utilised by patients in terms of primary care, secondary care, and tests/procedures by NYHA class. Costs were applied to resource use based on the results of the 3^rd phase, utilising UK-based reference costs (or expert elicitation where cost was not available). Results were assessed with and without inclusion of structural interventionalist responses to ensure representation of the entire obstructive HCM patient population.

RESULTS: A positive association between increasing (worsening) NYHA class and economic burden was observed. Excluding structural interventionalists, a mean assessment of £637, £1,242, £9,550, and £14,240 per patient year for class I-IV respectively was determined. Including structural interventionalists, the mean assessment was £771, £1,326, £9,323, and £14,483 respectively. In both analyses, secondary care resources accounted for the majority of costs driven primarily by inpatient costs; especially in classes NYHA III and IV.

CONCLUSIONS: Patients with symptomatic obstructive HCM pose a significant economic burden within the UK, with patients in more severe NYHA classes exhibiting higher costs to the system. A reduction in the symptomatic burden for these patients may have a substantial impact on healthcare system resource use.