Identifying and characterizing commercially insured patients with HFpEF with high vs low health care resource utilization.

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) represents half of all HF diagnoses and is a growing public health concern. Despite therapeutic advancements, HFpEF contributes to substantial health care resource utilization (HCRU) and costs. Characterizing these measures and identifying potential associations in HFpEF is needed.

Objective: To characterize the HCRU and costs among the bottom 10th and top 90th percentiles of total health care cost, examine associations of belonging to the 90th percentile, and analyze trends over time.

Methods: We conducted a retrospective cohort study using the Merative MarketScan database to examine commercially insured adults diagnosed with HFpEF from 2014 to 2021. HCRU and costs were estimated using a Cox proportional hazards model and Kaplan-Meier sample average techniques, bootstrapping was applied to generate credible intervals. Predictors of high HCRU were identified using a multivariable logistic regression model.

Results: We had 24,071 eligible participants. The HCRU among the 90th percentile possessed an annual incremental average of 13 emergency department/urgent care visits, 3 inpatient admissions, and 30 days in the hospital. Total health care costs of the 90th percentile were $378,880 higher on average than the 10th percentile. Both cohorts experienced the highest HCRU and costs the first month after diagnosis. Credible intervals of total costs from bootstrapping overlapped from 2014 to 2021. Baseline characteristics associated with the 90th percentile included female sex (odds ratio [OR] = 1.13; 95% CI = 1.1-1.2), a Charlson comorbidity index (CCI) score of 2 (OR = 3.28; 95% CI = 3.0-3.6), and a CCI score greater than 2 (OR = 18.81; 95% CI = 16.9-20.9). Comorbidities associated with the 90th percentile included atrial fibrillation (OR = 3.51; 95% CI = 2.8-4.4), loop diuretics (OR = 2.18; 95% CI = 2.0-2.4), angiotensin receptor-neprilysin inhibitor (OR = 1.89; 95% CI = 1.1-3.2), and sodium-glucose cotransporter-2 inhibitors (OR = 4.48; 95% CI = 3.0-6.7). Comorbidities associated with the 10th percentile included diabetes (OR = 0.53; 95% CI = 0.4-0.7), hypertension (OR = 0.71; 95% CI = 0.6-0.8), and chronic kidney disease (OR = 0.63; 95% CI = 0.4-0.9). Interactions indicating multiple comorbidities were significant.

Conclusions: Significant differences in HCRU exist between high- and low-cost patients with HFpEF. However, both groups experienced their highest utilization the first month after diagnosis. Total costs remained consistent from 2014 to 2022. Strategies to reduce the risk of HFpEF onset are essential for lowering health care expenditures. Future research is needed to examine the impact of access to newer therapies.