OBJECTIVES: Heart failure (HF) is a common and serious disease in the United States and in Europe. Approximately 6.5 million adults in the United States have HF, and 1 in 8 deaths included HF as a contributing cause of death. Patients with HF often need to be treated for fluid overload, resulting in costly inpatient visits; however, limited published evidence exists on the hospital costs of alternative treatments for fluid overload in these patients. This study performed a cost analysis of ultrafiltration (UF) vs. diuretic therapy (DIUR-T) for patients with HF from the hospital perspective.

METHODS: The model used a decision-analytic framework reflecting treatment decisions, probabilistic outcomes, and associated costs for treating patients with HF and hypervolemia with either veno-venous UF or intravenous DIUR-T. The model was informed by clinical data from the published literature and hospital cost data from the Healthcare Cost and Utilization Project (HCUP). This approach provided estimates of the expected costs of each treatment to the hospital. A 90-day timeframe was considered in the model to account for hospital readmissions beyond 30 days. Sensitivity and scenario analyses were performed to gauge the robustness of the results.

RESULTS: Although initial hospitalization costs were higher, fluid removal by UF substantially reduced hospital readmission days, leading to cost savings at the 90-day follow-up. Specifically, 90-day hospital costs were $23,633 with UF and $27,608 with DIUR-T, a savings of $3,975 (14%). These results were robust in the sensitivity analysis and across a number of alternative treatment scenarios.

CONCLUSIONS: When treating fluid overload in patients with HF, UF is a viable alternative to DIUR-T. Despite higher up-front costs, UF substantially reduced hospital costs over a 90-day period compared to DIUR-T. These cost savings are attributed to reduced readmission rates and duration.