From Chronic to Acute Models of Heart Failure – The Cost-Effectiveness Perspective

Cost-effectiveness is a new and rapidly expanding field of modern medicine. As new therapies continue to be introduced in the market, some of them being quite expensive, the cost related to healthcare in different clinical settings is constantly increasing. Therefore, a modern approach in healthcare politics is based on the calculation of cost-effectiveness, which reflects the balance between the cost of a therapy and its efficiency, translated into years of survival or quality of life. Heart failure (HF) is a disease which consumes a significant part of healthcare budget, most of its expenditures being represented by hospitalization costs. Several published studies reported that approximately two-thirds of the healthcare costs of HF are related to hospitalization.1,2 A current cost-of-illness systematic review highlights the latest worldwide estimations, suggesting that approximately 26 million individuals are affected by HF,3 with an expected prevalence of at least 3% by 2030, leading some to describe it as a global pandemic.4 Annually, both Europe and the US spend 1–2% of their healthcare resources for the management of HF.5 In terms of global economic burden, the healthcare of patients with HF has been assessed at $108 billion each year, with $65 billion credited to direct and $43 billion to indirect costs. The United States represents the largest contributor to worldwide HF charges and is responsible for 28.4% of overall HF costs, while Europe accounts for 6.83% of overall HF expenditure.6 Patients with chronic HF require frequent rehospitalizations, which significantly increases the economic burden of this devastating disease. A recently published review confirms that hospital admission-related costs contribute significantly to global HF-related direct costs, in a percentage between 44% and 96%.3 These readmissions proved to be specifically resource-intensive, as healthcare costs were estimated to $83,980 over the lifetime of each patient with HF. Another study reported that from global lifetime healthcare costs related to HF, almost 80% were associated with hospital stays.7 Chronic HF is a condition in which the heart cannot pump sufficient blood into the circulation to satisfy the needs of the entire body. The latest statistical report of the American Heart Association estimates that 0.4–2.2% of the population in industrialized states present this condition, with between 500,000–600,000 incident cases diagnosed per year.8 As a chronic disease, HF involves great lifetime expenses, mainly in the first year after diagnosis, while end-of-life healthcare is defined as the most expensive one.2 During the evolution of chronic HF, repeated episodes of acute decompensation can occur, which require immediate admission. A randomized controlled trial investigating outcomes in subjects with chronic HF reported that two-thirds of the subjects presented hospital readmission within the first year.9 Moreover, a recently published study demonstrated 30-day readmission rates for HF even higher than for acute myocardial infarction.10 Taking into account the substantial cost impact of HF on healthcare systems, it is mandatory to have a better consideration of the cost aspects and the specific cost drivers in different forms of this disease. Anemia is a frequent comorbidity in patients with From Chronic to Acute Models of Heart Failure – The Cost-Effectiveness Perspective