Economic burden of hospitalizations of Medicare beneficiaries with heart failure

Meredith Kilgore, Harshali K Patel, Adrian Kielhorn, Juan F Maya, Pradeep Sharma, Meredith Kilgore, Harshali K Patel, Adrian Kielhorn, Juan F Maya, Pradeep Sharma

Abstract

Objective: The objective of this study was to assess the costs associated with the hospitalization and the cumulative 30-, 60-, and 90-day readmission rates in a cohort of Medicare beneficiaries with heart failure (HF).

Methods: This was a retrospective, observational study based on data from the national 5% sample of Medicare beneficiaries. Inpatient data were gathered for Medicare beneficiaries with at least one HF-related hospitalization between July 1, 2005, and December 31, 2011. The primary end point was the average per-patient cost of hospitalization for individuals with HF. Secondary end points included the cumulative rate of hospitalization, the average length of hospital stay, and the cumulative 30-, 60-, and 90-day readmission rates.

Results: Data from 63,678 patients with a mean age of 81.8 years were included in the analysis. All costs were inflated to $2,015 based on the medical care component of the Consumer Price Index. The mean per-patient cost of an HF-related hospitalization was $14,631. The mean per-patient cost of a cardiovascular (CV)-related or all-cause hospitalization was $16,000 and $15,924, respectively. The cumulative rate of all-cause hospitalization was 218.8 admissions per 100 person-years, and the median length of stay for HF-related, CV-related, and all-cause hospitalizations was 5 days. Also, 22.3% of patients were readmitted within 30 days, 33.3% were readmitted within 60 days, and 40.2% were readmitted within 90 days.

Conclusion: The costs associated with hospitalization for Medicare beneficiaries with HF are substantial and are compounded by a high rate of readmission.

Keywords: Medicare; costs; health economics; heart failure; hospitalization.

Conflict of interest statement

Disclosure MK and PS have previously received grants/research support from Amgen, Inc. HKP, AK, and JM are employees of Amgen, Inc. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Patient selection. Abbreviations: HF, heart failure, HMO, Health Maintenance Organization.
Figure 2
Figure 2
Hospitalization costs by type (mean). Notes: Other, other insurance, deductibles, and copayments. Abbreviations: CMS, Centers for Medicare and Medicaid Services; CV, cardiovascular; HF, heart failure.
Figure 3
Figure 3
All-cause 30- and 60-day readmission rates by year.

References

    1. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics–2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29–e322.
    1. Juenger J, Schellberg D, Kraemer S, et al. Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables. Heart. 2002;87(3):235–241.
    1. Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6(3):606–619.
    1. Gheorghiade M, De Luca L, Fonarow GC, Filippatos G, Metra M, Francis GS. Pathophysiologic targets in the early phase of acute heart failure syndromes. Am J Cardiol. 2005;96(6A):11G–17G.
    1. Gheorghiade M, Zannad F, Sopko G, et al. Acute heart failure syndromes: current state and framework for future research. Circulation. 2005;112(25):3958–3968.
    1. Dunlay SM, Redfield MM, Weston SA, et al. Hospitalizations after heart failure diagnosis a community perspective. J Am Coll Cardiol. 2009;54(18):1695–1702.
    1. Dunlay SM, Shah ND, Shi Q, et al. Lifetime costs of medical care after heart failure diagnosis. Circ Cardiovasc Qual Outcomes. 2011;4(1):68–75.
    1. McHugh MD, Ma C. Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Med Care. 2013;51(1):52–59.
    1. Centers for Medicare & Medicaid Services Readmissions Reduction Program (HRRP) [Accessed May 16, 2016]. Available from: .
    1. Readmissions and deaths-national. 2016. [Accessed May 16, 2016]. Available from: .
    1. World Health Organization Prevention of cardiovascular disease: guidelines for assessment and management of cardiovascular risk. [Accessed May 16, 2016]. Available from: . Published August 2007.
    1. Lang CC, Mancini DM. Non-cardiac comorbidities in chronic heart failure. Heart. 2007;93(6):665–671.
    1. Greiner MA, Hammill BG, Fonarow GC, et al. Predicting costs among Medicare beneficiaries with heart failure. Am J Cardiol. 2012;109(5):705–711.
    1. van Deursen VM, Urso R, Laroche C, et al. Co-morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Eur J Heart Fail. 2014;16(1):103–111.
    1. Linden A, Adler-Milstein J. Medicare disease management in policy context. Health Care Financ Rev. 2008;29(3):1–11.
    1. Joynt KE, Jha AK. Who has higher readmission rates for heart failure, and why? Implications for efforts to improve care using financial incentives. Circ Cardiovasc Qual Outcomes. 2011;4(1):53–59.
    1. Centers for Medicare & Medicaid Services Geographic variation public use file. [Accessed May 16, 2016]. Available from: .
    1. Friedman B, Jiang HJ, Russo CA. Medicare hospital stays: comparisons between the fee-for-service plan and alternative plans, 2006: Statistical Brief #66. [Accessed May 16, 2016]. Available from:
    1. Polinski JM, Donohue JM, Kilabuk E, Shrank WH. Medicare Part D’s effect on the under- and overuse of medications: a systematic review. J Am Geriatr Soc. 2011;59(10):1922–1933.

Source: PubMed

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