Advertisement

Journal of Public Health

, Volume 20, Issue 1, pp 23–30 | Cite as

Resource use and costs in systolic heart failure according to disease severity: a pooled analysis from the German Competence Network Heart Failure

  • Janine Biermann
  • Till Neumann
  • Christiane E. Angermann
  • Hans-Dirk Düngen
  • Raimund Erbel
  • Wolfgang Herzog
  • Bernhard Maisch
  • Thomas Müller-Tasch
  • Cemil Özcelik
  • Sabine Pankuweit
  • Burkert Pieske
  • David Pittrow
  • Vera Regitz-Zagrosek
  • Thomas Scheffold
  • Stefan Störk
  • Rolf Wachter
  • Götz Gelbrich
  • Jürgen Wasem
  • Anja Neumann
Original Article

Abstract

Aim

Systolic chronic heart failure (CHF) is currently one of the most prevalent cardiac diseases. The present analysis sought to estimate the 1-year disease-related resource use and associated management costs of patients with CHF.

Subject and methods

A total of 2,710 individuals with systolic CHF [mean age 62.9 years ± 13.6, 25.2% female, New York Heart Association (NYHA) I–IV] were included from the German Competence Network Heart Failure. Disease-related resource use was assessed with regard to outpatient contacts with physicians, hospitalizations including rehabilitation stays and drug utilization.

Results

During 1 year, patients had on average 6.1 contacts with their general practitioner, 1.7 contacts with cardiologists and 0.8 hospital stays per year. Overall disease-related health care costs per patient were calculated at 3,150 € per year. The largest component related to hospitalizations (2,328 €, 74%), while costs of rehabilitation (294 €, 9%), medication (290 €, 9%) and outpatient contacts (238 €, 8%) were considerably lower. Compared with 2,474 € in NYHA class I, there was a cost increase in NYHA II, III and IV of 14, 48 and 71%, respectively. About 76% of this cost increase resulted from augmented hospital (inpatient) resource use.

Conclusion

The present analysis demonstrates a high disease-related resource consumption of heart failure care. In particular, patients in higher NYHA classes require increased inpatient resources. Hence, improved treatment strategies need to be developed to optimize care thus reducing hospitalization rates.

Keywords

Economic evaluation Heart failure Resource use Costs 

Notes

Acknowledgement

This work was supported by the Competence Network of Heart Failure funded by the Federal Ministry of Education and Research (BMBF), FKZ 01GI0205.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. Berry C, Murdoch DR, McMurray JJ (2001) Economics of chronic heart failure. Eur J Heart Fail 3:283–291PubMedCrossRefGoogle Scholar
  2. Biermann J, Mostardt S, Neumann T et al (2010) Kosteneffektivität des Einsatzes von Studienschwestern in der Betreuung von Patienten mit Herzinsuffizienz. Ein systematisches Review. Herz 35:273–283PubMedCrossRefGoogle Scholar
  3. Brouwer W, Rutten F, Koopmanschap M (2001) Costing in economic evaluations. In: Drummond M, McGuire A (eds) Economic evaluation in health care: merging theory with practice. Oxford University Press, Oxford, pp 68–93Google Scholar
  4. Bui AL, Horwich TB, Fonarow GC (2011) Epidemiology and risk profile of heart failure. Nat Rev Cardiol 8:30–41. doi: 10.1038/nrcardio.2010.165 Google Scholar
  5. Cleland JG, Khand AU, Clark AL (2001) The heart failure epidemic: exactly how big is it? Eur Heart J 22:623–626PubMedCrossRefGoogle Scholar
  6. Cleland JG, Swedberg K, Follath F et al (2003) The EuroHeart Failure survey programme—a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J 24:442–463PubMedCrossRefGoogle Scholar
  7. Cowie MR, Zaphiriou A (2002) Management of chronic heart failure. BMJ 325:422–425PubMedCrossRefGoogle Scholar
  8. Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology, Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 29:2388–2442PubMedCrossRefGoogle Scholar
  9. Komajda M, Follath F, Swedberg K et al (2003) The EuroHeart Failure Survey programme—a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment. Eur Heart J 24:464–474PubMedCrossRefGoogle Scholar
  10. Krauth C, Hessel F, Hansmeier T et al (2005) Empirical standard costs for health economic evaluation in Germany—a proposal by the working group methods in health economic evaluation. Gesundheitswesen 67:736–746PubMedCrossRefGoogle Scholar
  11. Liao L, Anstrom KJ, Gottdiener JS et al (2007) Long-term costs and resource use in elderly participants with congestive heart failure in the Cardiovascular Health Study. Am Heart J 153:245–252PubMedCrossRefGoogle Scholar
  12. Lloyd-Jones D, Adams RJ, Brown TM et al (2010) Heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation 121:e46–e215PubMedCrossRefGoogle Scholar
  13. Luce BR, Manning WG, Siegel JE, Lipscomb J (1996) Estimating costs in cost-effectiveness analysis. In: Gold MR, Siegel JE, Russel LB, Weinstein MC (eds) Cost-effectiveness in health and medicine. Oxford University Press, New York, pp 176–213Google Scholar
  14. McMurray JJ, Petrie MC, Murdoch DR et al (1998) Clinical epidemiology of heart failure: public and private health burden. Eur Heart J 19(Suppl P):P9–P16PubMedGoogle Scholar
  15. Mehrhof F, Löffler M, Gelbrich G et al (2010) A network against failing hearts—introducing the German “Competence Network Heart Failure”. Int J Cardiol 145:135–138PubMedCrossRefGoogle Scholar
  16. Miller G, Randolph S, Forkner E et al (2009) Long-term cost-effectiveness of disease management in systolic heart failure. Med Decis Making 29:325–333PubMedCrossRefGoogle Scholar
  17. Neumann T, Biermann J, Erbel R et al (2009) Heart failure: the commonest reason for hospital admission in Germany: medical and economic perspectives. Dtsch Arztebl Int 106:269–275. doi: 10.3238/arztebl.2009.0269 PubMedGoogle Scholar
  18. Owan TE, Hodge DO, Herges RM et al (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355:251–259PubMedCrossRefGoogle Scholar
  19. Schwabe U, Paffrath D (eds) (2010) Arzneiverordnungs-Report 2010: Aktuelle Daten, Kosten, Trends und Kommentare. Springer, BerlinGoogle Scholar
  20. Stewart S, Jenkins A, Buchan S et al (2002) The current cost of heart failure to the National Health Service in the UK. Eur J Heart Fail 4:361–371PubMedCrossRefGoogle Scholar
  21. Szucs TD (2003) Gesundheitsökonomische Aspekte der chronischen Herzinsuffizienz. Teil 1: Krankheitslast und ökonomische Bewertung. Schweiz Arzteztg 84:2431–2435Google Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Janine Biermann
    • 1
    • 2
  • Till Neumann
    • 1
  • Christiane E. Angermann
    • 3
  • Hans-Dirk Düngen
    • 4
  • Raimund Erbel
    • 1
  • Wolfgang Herzog
    • 5
  • Bernhard Maisch
    • 6
  • Thomas Müller-Tasch
    • 5
  • Cemil Özcelik
    • 4
  • Sabine Pankuweit
    • 6
  • Burkert Pieske
    • 7
  • David Pittrow
    • 8
  • Vera Regitz-Zagrosek
    • 9
  • Thomas Scheffold
    • 10
  • Stefan Störk
    • 3
  • Rolf Wachter
    • 11
  • Götz Gelbrich
    • 12
  • Jürgen Wasem
    • 2
  • Anja Neumann
    • 2
  1. 1.Clinic of CardiologyUniversity Hospital EssenEssenGermany
  2. 2.Institute for Health Care Management and ResearchUniversity of Duisburg-EssenEssenGermany
  3. 3.Department of Internal Medicine I and Comprehensive Heart Failure CenterUniversity Hospital WürzburgWürzburgGermany
  4. 4.Department CardiologyCharité University Medicine, Campus Virchow KlinikumBerlinGermany
  5. 5.Department of General Internal Medicine and PsychosomaticsUniversity Hospital HeidelbergHeidelbergGermany
  6. 6.Department of Internal Medicine – CardiologyUniversity Hospital Giessen and MarburgMarburgGermany
  7. 7.Department of CardiologyUniversity GrazGrazAustria
  8. 8.Department for Clinical Pharmacology, Medical Faculty, Karl Gustav CarusTechnical University of DresdenDresdenGermany
  9. 9.Department of Cardiovascular Diseases in WomenCharité University MedicineBerlinGermany
  10. 10.Institute for Heart and Circulation ResearchUniversity of Witten/HerdeckeDortmundGermany
  11. 11.Department of Cardiology and PneumologyGeorg-August University GöttingenGöttingenGermany
  12. 12.Clinical Trial Centre LeipzigUniversity of LeipzigLeipzigGermany

Personalised recommendations