OBJECTIVES: Clinically significant mitral regurgitation (MR) is associated with healthcare expenditures. This claims analysis evaluates whether a therapeutic intensity (TIS) score in the economic analysis of incident heart failure patients (HF) with secondary MR may impact all-cause annual healthcare expenditures.

METHODS: Data from the Truven Health MarketScan Commercial Claims and Medicare Supplemental Databases from October 2011 to September 2016 was analyzed. Patients had a minimum of 1 inpatient or 2 outpatient claims for HF with a 6-month pre-period (baseline). A 6-month post-period (landmark) after HF index was used to capture MR diagnosis and severity. Following the landmark period, patients were required to have 12 months of continuous medical and prescription drug plan enrollment with at least two records of HF medication refills. Additional exclusions (under age 18, chordal rupture, hospice, etc) were applied. TIS was calculated based on a patient’s pharmacologic regimen with drug categories including: ACE inhibitors, angiotensin receptor blockers, beta blockers, diuretics, etc. Within categories, each fill was assigned 1 to 3 points depending on dose, then summated across categories, with the highest score of 24. HF patients were separated into three cohorts: without MR, not clinically significant MR (nsMR), and significant MR (sMR). Healthcare all-cause expenditures were modeled.

RESULTS: HF patients with sMR had the highest TIS at a mean of 6.9, then nsMR at 6.5, and no MR at 5.9. Based on the regression model, sMR was associated with a $2,729 (95% CI $1,405, $4,052; P<.0001) increase in all-cause healthcare expenditures in the 12 months after the landmark period. Every point increase of TIS was associated with a $1,506 ($1,402, $1,610; P<.0001) increase in expenditures.

CONCLUSIONS: Clinically significant MR is an important driver of healthcare expenditures, and the intensity of heart failure medical therapy should be considered when estimating the economic burden of illness.