OBJECTIVES: Heart failure (HF) is among the leading causes of hospitalization in Canada, imposing a high burden on individuals and society, as well as a substantial economic burden on the healthcare system. The objective of this study was to assess resource utilization and direct medical costs incurred by HF patients in the first two years after an initial hospitalization for HF in Nova Scotia, Canada.

METHODS: A retrospective cohort study was conducted using population-based administrative health databases from Nova Scotia. The cohort consisted of adults with an incident hospitalization for HF between April 2009 and March 2013 and were all followed until March 2015. Resource utilization included use of inpatient, outpatient, and pharmaceutical resources. Costs are reported overall and by category of resource utilization. Pharmaceutical data were not available for individuals <65 years; as such, pharmaceutical utilization and costs were not reported for this age stratum.

RESULTS: There were 6,851 HF patients included in this study, with 83% of cases ≥65 years. In the first year post-index hospitalization, 55% were re-hospitalized, with a median of 32 outpatient visits. Inpatient and outpatient costs were similar across age groups; the overall mean cost (2017 CAD) per-person was $38,294 (95% confidence interval [CI] $36,916-$39,672) in post-index year 1 and $15,893 (95% CI $14,648-$17,137) post-index year 2. In both years, more than 95% of these costs were related to inpatient care. In individuals ≥65 years, mean drug costs were shown to be an additional $1,953 post-index year 1 and $1,140 post-index year 2.

CONCLUSIONS: The first year following a diagnosis of HF is associated with the highest overall direct medical costs, primarily driven by hospitalizations. Compared to the average per-capita healthcare expenditures in Nova Scotia, healthcare costs in the year following a diagnosis of HF were approximately three-fold higher than age-matched per-capita costs.