William Hollingworth1, Mousumi Biswas2, Rachel L Maishman3, Mark J Dayer4, Theresa McDonagh5, Sarah Purdy2, Barnaby C Reeves3, Chris A Rogers3, Rachael Williams6, Maria Pufulete3. 1. School of Social and Community Medicine, University of Bristol, Bristol, UK. Electronic address: William.hollingworth@bristol.ac.uk. 2. School of Social and Community Medicine, University of Bristol, Bristol, UK. 3. Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK. 4. Department of Cardiology, Taunton and Somerset NHS Foundation Trust, Taunton, UK. 5. King's College Hospital, London, UK. 6. Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK.
Abstract
BACKGROUND: Evidence on the economic impact of heart failure (HF) is vital in order to predict the cost-effectiveness of novel interventions. We estimate the health system costs of HF during the last five years of life. METHODS: We used linked primary care and mortality data accessed through the Clinical Practice Research Datalink (CPRD) to identify 1555 adults in England who died with HF in 2012/13. We used CPRD and linked Hospital Episode Statistics to estimate the cost of medications, primary and hospital healthcare. Using GLS regression we estimated the relationship between costs, HF diagnosis, proximity to death and patient characteristics. RESULTS: In the last 3months of life, healthcare costs were £8827 (95% CI £8357 to £9296) per patient, more than 90% of which were for inpatient or critical care. In the last 3months, patients spent on average 17.8 (95% CI 16.8 to 18.8) days in hospital and had 8.8 (95% CI 8.4 to 9.1) primary care consultations. Most (931/1555; 59.9%) patients were in hospital on the day of death. Mean quarterly healthcare costs in quarters after HF diagnosis were higher (£1439; [95% CI £1260 to £1619]) than in quarters preceding diagnosis. Older patients and patients with lower comorbidity scores had lower costs. CONCLUSIONS: Healthcare costs increase sharply at the end of life and are dominated by hospital care. There is potential to save money by implementation and evaluation of interventions that are known to reduce hospitalisations for HF, particularly at the end of life.
BACKGROUND: Evidence on the economic impact of heart failure (HF) is vital in order to predict the cost-effectiveness of novel interventions. We estimate the health system costs of HF during the last five years of life. METHODS: We used linked primary care and mortality data accessed through the Clinical Practice Research Datalink (CPRD) to identify 1555 adults in England who died with HF in 2012/13. We used CPRD and linked Hospital Episode Statistics to estimate the cost of medications, primary and hospital healthcare. Using GLS regression we estimated the relationship between costs, HF diagnosis, proximity to death and patient characteristics. RESULTS: In the last 3months of life, healthcare costs were £8827 (95% CI £8357 to £9296) per patient, more than 90% of which were for inpatient or critical care. In the last 3months, patients spent on average 17.8 (95% CI 16.8 to 18.8) days in hospital and had 8.8 (95% CI 8.4 to 9.1) primary care consultations. Most (931/1555; 59.9%) patients were in hospital on the day of death. Mean quarterly healthcare costs in quarters after HF diagnosis were higher (£1439; [95% CI £1260 to £1619]) than in quarters preceding diagnosis. Older patients and patients with lower comorbidity scores had lower costs. CONCLUSIONS: Healthcare costs increase sharply at the end of life and are dominated by hospital care. There is potential to save money by implementation and evaluation of interventions that are known to reduce hospitalisations for HF, particularly at the end of life.
Authors: Syed Mohiuddin; Barnaby Reeves; Maria Pufulete; Rachel Maishman; Mark Dayer; John Macleod; Theresa McDonagh; Sarah Purdy; Chris Rogers; William Hollingworth Journal: BMJ Open Date: 2016-12-28 Impact factor: 2.692
Authors: Maria Pufulete; Rachel Maishman; Lucy Dabner; Julian P T Higgins; Chris A Rogers; Mark Dayer; John MacLeod; Sarah Purdy; William Hollingworth; Morten Schou; Manuel Anguita-Sanchez; Patric Karlström; Michael Kleiner Shochat; Theresa McDonagh; Angus K Nightingale; Barnaby C Reeves Journal: Syst Rev Date: 2018-07-31
Authors: Clare J Taylor; José M Ordóñez-Mena; Andrea K Roalfe; Sarah Lay-Flurrie; Nicholas R Jones; Tom Marshall; F D Richard Hobbs Journal: BMJ Date: 2019-02-13
Authors: Arlene M Gallagher; Daniel Dedman; Shivani Padmanabhan; Hubert G M Leufkens; Frank de Vries Journal: Pharmacoepidemiol Drug Saf Date: 2019-03-25 Impact factor: 2.890