Journal of Public Health

, Volume 20, Issue 6, pp 653–660 | Cite as

What drives the costs of heart failure care in Germany? A health services cost analysis

  • Frank Peters-KlimmEmail author
  • Anna Halmer
  • Steffen Flessa
  • Joachim Szecsenyi
  • Dominik Ose
Original Article



Heart failure (HF) represents an increasing burden on health-care systems because of the aging population. The aim of this study was to explore its costs of care in Germany from the payer perspective and to identify the main drivers.

Subjects and methods

As part of a trial, primary care physicians (PCPs) enrolled eligible patients and documented actual clinical and 12-month retrospective ambulatory health-care utilisation data related to HF [PCP and cardiologist contacts, and cardiovascular (CV) medication] and provided the doctors’ reports of hospitalisations during 2004 and 2005, enabling the collection and calculation of costs. Furthermore, each hospitalisation was classified according to the cause of admission into HF, CV or other hospitalisation.


Thirty-seven physicians enrolled 168 patients with complete data of 159 patients (95 %). Patients (mean age 68 ± 10 years, 73 % male, 47 % ischaemic aetiology) had ascertained systolic HF (mean ejection fraction 33 ± 7 %) with NYHA class II/III in 53/45 %. Mean (SD; median) annual costs of 96 hospitalisations, CV medication, and 337 cardiologist and 3,037 PCP practice contacts were 3,545 (8,065; 0), 854 (835; 638), 117 (105; 106) and 269 (190; 233) euros, respectively, totalling 4,792 (8249;1341) euros. Fourteen per cent of all patients incurred 50 % of total costs. Twenty-five HF, 49 CV and 22 other hospitalisations incurred 13, 73 and 14 % of hospital care costs, respectively.


These secondary outcome data might indicate a trend that neither HF ambulatory care nor hospitalisation but rather interventional cardiology is the main cost driver. Planning interventions aimed at reduced hospitalisation and costs should include further clarification of the mechanisms of CV hospitalisation and reimbursement.

Key words

Heart failure Hospitalisation Hospital admission Cost of illness Germany 



We thank all study participants and participating PCPs for their additional participation in the cost of care study.

Conflict of interest

The authors declare that they have no conflict of interest.


The parental trial was supported by the Competence Network Heart Failure, funded by the German Ministry of Education and Research (BMBF), grant no. 01GI0205.

Supplementary material

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Frank Peters-Klimm
    • 1
    Email author
  • Anna Halmer
    • 1
  • Steffen Flessa
    • 2
  • Joachim Szecsenyi
    • 1
  • Dominik Ose
    • 1
  1. 1.Department of General Practice and Health Services ResearchUniversity Hospital HeidelbergHeidelbergGermany
  2. 2.Department of Health Care Management, Faculty of Law and EconomicsUniversity GreifswaldGreifswaldGermany

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