P G Davey1, P B Clarkson, A McMahon, T M MacDonald. 1. MEMO (Medicines Monitoring), University Department of Clinical Pharmacology, Ninewells Hospital & Medical School, Dundee, Scotland. peter@memo.dundee.ac.uk
Abstract
OBJECTIVE: To investigate whether the extent of systolic dysfunction is a useful predictor of the costs of healthcare and social support for patients with heart failure. DESIGN: Cross-sectional study with collection of cost data attributed to management of heart failure in the previous year. SETTING: Four primary-care practices in Scotland. PATIENTS: Patients receiving long term therapy with loop diuretics for suspected heart failure. INTERVENTIONS: Two-dimensional and Doppler echocardiography. MAIN OUTCOME MEASURES AND RESULTS: Two hypotheses were tested: (i) the proportion of patients incurring costs is higher in patients with abnormal left ventricular (LV) function; and (ii) the median cost per patient that incurs costs is higher in patients with abnormal LV function. Of the 226 patients in the study, 67 (30%) had abnormal systolic function. In comparison with the remaining 159 patients, they had higher healthcare costs [560 Pounds vs 440 Pounds per patient year (1994/1995 values)], were more likely to incur hospital inpatient or outpatient costs [Odds ratio (OR): 2.02; 95% confidence interval (CI): 1.06 to 3.84] and had significantly higher primary-care costs (mean 292 Pounds vs 231 Pounds per patient year; p = 0.02, Mann Whitney test). In contrast, they were no more likely to incur social support costs (OR: 1.22; 95% CI: 0.52 to 2.86) and the mean cost of social support per patient year was lower (234 Pounds vs 373 Pounds). CONCLUSIONS: Patients with objectively measured systolic dysfunction incurred significantly higher healthcare costs in the year before diagnosis. This suggests that treatment that improves systolic function will reduce healthcare costs, even in a primary-care population with relatively mild congestive heart failure.
OBJECTIVE: To investigate whether the extent of systolic dysfunction is a useful predictor of the costs of healthcare and social support for patients with heart failure. DESIGN: Cross-sectional study with collection of cost data attributed to management of heart failure in the previous year. SETTING: Four primary-care practices in Scotland. PATIENTS: Patients receiving long term therapy with loop diuretics for suspected heart failure. INTERVENTIONS: Two-dimensional and Doppler echocardiography. MAIN OUTCOME MEASURES AND RESULTS: Two hypotheses were tested: (i) the proportion of patients incurring costs is higher in patients with abnormal left ventricular (LV) function; and (ii) the median cost per patient that incurs costs is higher in patients with abnormal LV function. Of the 226 patients in the study, 67 (30%) had abnormal systolic function. In comparison with the remaining 159 patients, they had higher healthcare costs [560 Pounds vs 440 Pounds per patient year (1994/1995 values)], were more likely to incur hospital inpatient or outpatient costs [Odds ratio (OR): 2.02; 95% confidence interval (CI): 1.06 to 3.84] and had significantly higher primary-care costs (mean 292 Pounds vs 231 Pounds per patient year; p = 0.02, Mann Whitney test). In contrast, they were no more likely to incur social support costs (OR: 1.22; 95% CI: 0.52 to 2.86) and the mean cost of social support per patient year was lower (234 Pounds vs 373 Pounds). CONCLUSIONS:Patients with objectively measured systolic dysfunction incurred significantly higher healthcare costs in the year before diagnosis. This suggests that treatment that improves systolic function will reduce healthcare costs, even in a primary-care population with relatively mild congestive heart failure.
Authors: T A McDonagh; C E Morrison; A Lawrence; I Ford; H Tunstall-Pedoe; J J McMurray; H J Dargie Journal: Lancet Date: 1997-09-20 Impact factor: 79.321
Authors: T A McDonagh; S D Robb; D R Murdoch; J J Morton; I Ford; C E Morrison; H Tunstall-Pedoe; J J McMurray; H J Dargie Journal: Lancet Date: 1998-01-03 Impact factor: 79.321