Indirect costs and public finance consequences of heart failure in Poland, 2012-2015

Heart failure: a prevalence-based and model-based cost analysis

Introduction

Heart failure (HF) imposes a heavy economic burden on patients, their families, and society as a whole. Therefore, it is crucial to quantify the impact and dimensions of the disease in order to prioritize and allocate resources effectively.

Methods

This study utilized a prevalence-based, bottom-up, and incidence-based Markov model to assess the cost of illness. A total of 502 HF patients (classes I-IV) were recruited from Madani Hospital in Tabriz between May and October 2022. Patients were followed up every two months for a minimum of two and a maximum of six months using a person-month measurement approach. The perspective of the study was societal, and both direct and indirect costs were estimated. Indirect costs were calculated using the Human Capital (HC) method. A two-part regression model, consisting of the Generalized Linear Model (GLM) and Probit model, was used to analyze the relationship between HF costs and clinical and demographic variables.

Results

The total cost per patient in one year was 261,409,854.9 Tomans (21,967.21 PPP). Of this amount, 207,147,805.8 Tomans (17,407.38 PPP) (79%) were indirect costs, while 54,262,049.09 Tomans (4,559.84 PPP) (21%) were direct costs. The mean lifetime cost was 2,173,961,178 Tomans. Premature death accounted for the highest share of lifetime costs (48%), while class III HF had the lowest share (2%). Gender, having basic insurance, and disease class significantly influenced the costs of HF, while comorbidity and age did not have a significant impact. The predicted amount closely matched the observed amount, indicating good predictive power.

Conclusion

This study revealed that HF places a significant economic burden on patients in terms of both direct and indirect costs. The substantial contribution of indirect costs, which reflect the impact of the disease on other sectors of the economy, highlights the importance of unpaid work. Given the significant variation in HF costs among assessed variables, social and financial support systems should consider these variations to provide efficient and fair support to HF patients.

Valuation of health benefits of green-blue areas for the purpose of ecosystem accounting: a pilot in Flanders, Belgium

In recent years, a vast amount of scientific literature has highlighted the benefits of nearby green space for physical and mental health, but the large variation in scope, methods and indicators used in these studies hampers the assessment of these benefits in the context of natural capital accounting. To our knowledge, this paper is one of the first studies to quantify and value these benefits in the context of natural capital accounting. A method was developed and applied to the Flemish Region in Belgium for 2013 and 2016.

The physical supply and use accounts for health are based on a set of selected dose-effect relationships that quantify the impact of the availability of greenspace on seven specific indicators for physical and mental health, including mortality, cardio-vascular diseases, diabetes and depression. The indicator for green-blue areas is the percentage of green-blue areas in total land use, calculated for 0.5, 1 and 3 km radius from the residence, based on detailed land-use maps (10 m x 10 m) for Flanders, Belgium. The base-line data for mortality and illness are average data for the Flemish Region. These health impacts are weighted using Daly's (disability-adjusted life years) and aggregated. The total health benefits due to the availability of green-blue areas for the total Flemish population was estimated at almost 85,000 DALYs. This is 27% of the estimated total burden of disease in Flanders in 2016 for the seven selected diseases.

The monetary accounts are based on a detailed assessment for mortality and morbidity of three different cost components, i.e. avoided medical costs (e.g. hospitalisation) and avoided absenteeism and welfare loss due to suffering and reduced life expectancy. Productivity gains from avoided absenteeism is valued, based on statistics on absenteeism for specific diseases for and labour market data from Belgium and account for 52% of the total monetary value of green spaces. Cost of illness is valued, based on market data and illness specific studies for Belgium or Europe and account for 36% of total values. Welfare gains from increased life expectancy are valued on the basis of European studies for the VOLY (value of a life year lost), based on the simulated exchange value for the willingness-to-pay for increased life expectancy. This accounts for 12% of the total monetary value of green space. The total monetary benefits amount to 464 Euro per inhabitant per year or 3 billion Euro per year for Flanders. This corresponds to 1.3% of the GDP, which reflects the importance of these benefits.

The methodology is incomplete as not all health indicators are covered, mainly due to a lack of dose-effect relationships. The research priority for potential users of the accounts is a better indicator for contact with green space that does differentiate between ecosystems, their quality, accessibility or their use. This requires more systematic health impact studies that take these elements into account, as well as more systematic data on the daily use of green space by citizens. In the meantime, an additional set of condition accounts on these elements can be used, especially to follow changes in quality and use of green-blue areas over time.

Healthcare resource utilization and costs among patients with heart failure with preserved, mildly reduced, and reduced ejection fraction in Spain

AIMS

To describe healthcare resource utilization (HCRU) of patients with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) in Spain.  METHODS: Adults with ≥ 1 HF diagnosis and ≥ 1 year of continuous enrolment before the corresponding index date (1/January/2016) were identified through the BIG-PAC database. Rate per 100 person-years of all-cause and HF-related HCRU during the year after the index date were estimated using bootstrapping with replacement.

RESULTS

Twenty-one thousand two hundred ninety-seven patients were included, of whom 48.5% had HFrEF, 38.6% HFpEF and 4.2% HFmrEF, with the rest being of unknown EF. Mean age was 78.8 ± 11.8 years, 53.0% were men and 83.0% were in NYHA functional class II/III. At index, 67.3% of patients were taking renin angiotensin system inhibitors, 61.2% beta blockers, 23.4% aldosterone antagonists and 5.2% SGLT2 inhibitors. Rates of HF-related outpatient visits and hospitalization were 968.8 and 51.6 per 100 person-years, respectively. Overall, 31.23% of patients were hospitalized, mainly because of HF (87.88% of total hospitalizations); HF hospitalization length 21.06 ± 17.49 days (median 16; 25th, 75th percentile 9-27). HF hospitalizations were the main cost component: inpatient 73.64%, pharmacy 9.67%, outpatient 9.43%, and indirect cost 7.25%. Rates of all-cause and HF-related HCRU and healthcare cost were substantial across all HF subgroups, being higher among HFrEF compared to HFmrEF and HFpEF patients.

CONCLUSIONS

HCRU and cost associated with HF are high in Spain, HF hospitalizations being the main determinant. Medication cost represented only a small proportion of total costs, suggesting that an optimization of HF therapy may reduce HF burden.

Healthcare Expenditures Associated with Heart Failure in Saudi Arabia: A Cost of Illness Study

Heart failure (HF) is considered to be a global health problem that generates a significant economic burden. Despite the growing prevalence in Saudi Arabia, the economic burden of HF is not well studied. The aim of this study was to estimate the health care expenditures associated with HF in Saudi Arabia from a social perspective. We conducted a multicenter cost of illness (COI) study in two large governmental centers in Riyadh, Saudi Arabia using 369 HF patients. A COI model was developed in order to estimate the direct medical costs associated with HF. The indirect costs of HF were estimated based on a human capital approach. Descriptive and inferential statistics were analyzed. The direct medical cost per HF patient was $9563. Hospitalization costs were the major driver in total spending, followed by medication and diagnostics costs. The cost significantly increased in line with the disease progression, ranging from $3671 in class I to $16,447 in class IV. The indirect costs per working HF patient were $4628 due to absenteeism, and $6388 due to presenteeism. The economic burden of HF is significantly high in Saudi Arabia. Decision makers need to focus on allocating resources towards strategies that prevent frequent hospitalizations and improve HF management and patient outcomes in order to lower the growing economic burden.

Overview of the socio-economic consequences of heart failure

Heart failure (HF) is a frequent cause of morbidity and mortality worldwide. The prevalence of HF increases, and in high-income countries, 1-2% of total healthcare expenditure is spent on HF. This article gives an overview on the impact of HF on health-related quality of life (HRQoL) and the economic burden of HF. Those suffering from HF are associated with a substantial decrease of HRQoL compared to individuals with most other chronic diseases and to individuals without HF. Therapeutic approaches, which decrease risk factors and lead to an improvement of the clinical status of patients, have a positive effect on HRQoL of the patients. Hospitalization rates have been shown to be correlated with disease severity, mortality, and HRQoL. Inpatient treatments of HF patients are cost intensive and the most important component for the economic burden of HF, responsible for at least half of direct cost. Prevention strategies, diagnostic and therapeutic approaches should focus on avoiding need for hospitalizations, and in particular, readmissions. Outpatient care including medication represents the second largest cost component. The cost of HF varies from less than 1,000 USD per patient in low-income countries to between 5,000 and 15,000 EUR in Europe, and between 17,000 and 30,000 USD in the US. There is a lack of study results on indirect costs. All study results on the socio-economic burden of HF clearly underscore the public health relevance of HF, showing a large economic burden for healthcare systems all over the world and a considerable impact on patients' HRQoL. The results on HRQoL are relatively homogeneous, but there are large differences across countries in respect of the economic burden they have to bear. Despite the large number of studies on the socio-economic consequences of HF further research is necessary, especially on indirect cost and for low- and middle-income countries. Future studies would benefit from a greater standardization of methods and presentation of results.

10 year trends in hospitalization rates due to heart failure and related in-hospital mortality in Poland (2010-2019)

Aims

Heart failure (HF) remains a major public health challenge worldwide. Contemporary epidemiological data on HF hospitalization rates and related in‐hospital mortality are scarce also in Poland. The aim of the study was to determine the trends in hospitalization rates due to HF and related in‐hospital mortality in Poland in the recent decade.

Methods and results

Data on HF hospitalizations and in‐hospital mortality in patients aged >17 years in Poland between 2010 and 2019 were obtained from the central database of the Polish National Health Fund. Hospitalizations with either primary or secondary diagnosis of HF were identified using the 10th revision of the International Statistical Classification of Diseases and Related Health Problems codes (I50, I42, J81 with extensions, and R57.0). There were 4 259 698 HF hospitalizations and 608 577 in‐hospital deaths (14% in‐hospital mortality) reported during 2010–2019 in Poland. During this period, there was a steady increase in the number of HF hospitalizations per 1000 inhabitants in subsequent years, being more pronounced in men than in women (in 2019: 16 and 13 HF hospitalizations per 1000 inhabitants in men and women, respectively). The relative risk of HF hospitalization was higher in men than in women, and this gender‐related difference steadily increased from 9% in 2010 to 25% in 2019. During 2010–2019, there was an increase in the number of HF hospitalizations per 1000 inhabitants in subsequent age groups, with a trend being more pronounced in men than in women (129 and 99 HF hospitalizations per 1000 inhabitants in men and women aged ≥80 years, respectively). During this period, there was a slight increase in in‐hospital mortality during HF hospitalization in subsequent years, being more pronounced in women than in men (in 2019: 16% and 14% of in‐hospital mortality in women and men, respectively). The relative risk of in‐hospital mortality during HF hospitalization was higher in women than in men, and this gender‐related difference steadily increased from 8% in 2010 to 18% in 2019. During this period, in‐hospital mortality during HF hospitalization was ~12% for women and men aged 18–29 years, whereas the highest values of in‐hospital mortality reached ~19% for patients aged ≥80 years.

Conclusions

We have observed steady growing trends in HF hospitalization rates and related in‐hospital mortality in Poland over the last decade. Both age and gender have differentiated the reported epidemiological patterns.

Cognitive impairment in patients with heart failure: an international study

AIMS

Cognitive impairment (CI) in heart failure (HF) patients has mostly been studied in single countries in specific health care settings. Sociodemographic and clinical predictors of the global CI and CI dimensions are still unclear. We described CI in a diverse HF population recruited in several countries and in different health care settings and investigated sociodemographic and clinical factors associated with the global and specific CI dimensions in HF patients.

METHODS AND RESULTS

A secondary analysis from the baseline data of the Wii-HF trial. Patients (n = 605) were enrolled in Sweden, Italy, Israel, The Netherlands, Germany, and the United States. We used the Montreal Cognitive Assessment to evaluate CI and the 6 minute walk test (6MWT) to measure exercise capacity. Patients were on average 67 years old (SD, 12), and 86% were in New York Heart Association Class II and III. The mean Montreal Cognitive Assessment score was 24 (SD, 4), and 67% of patients had at least a mild CI. The item evaluating short-term memory had a considerable proportion of low scoring patients (28.1%). Worse CI was associated with patients' older age, lower education, and lower 6MWT scores (R² = 0.27). CI dimension scores were differently associated with specific clinical and demographic variables, but the 6MWT scores were associated with five out of seven CI dimension scores.

CONCLUSIONS

CI is an important problem in HF patients, with specific challenges in regard to memory. Exercise capacity is a modifiable factor that could be improved in HF patients with the potential to improve cognition and other outcomes in this population.

Artificial intelligence supported patient self-care in chronic heart failure: a paradigm shift from reactive to predictive, preventive and personalised care

Heart failure (HF) is one of the most complex chronic disorders with high prevalence, mainly due to the ageing population and better treatment of underlying diseases. Prevalence will continue to rise and is estimated to reach 3% of the population in Western countries by 2025. It is the most important cause of hospitalisation in subjects aged 65 years or more, resulting in high costs and major social impact. The current “one-size-fits-all” approach in the treatment of HF does not result in best outcome for all patients. These facts are an imminent threat to good quality management of patients with HF. An unorthodox approach from a new vision on care is required. We propose a novel predictive, preventive and personalised medicine approach where patients are truly leading their management, supported by an easily accessible online application that takes advantage of artificial intelligence. This strategy paper describes the needs in HF care, the needed paradigm shift and the elements that are required to achieve this shift. Through the inspiring collaboration of clinical and high-tech partners from North-West Europe combining state of the art HF care, artificial intelligence, serious gaming and patient coaching, a virtual doctor is being created. The results are expected to advance and personalise self-care, where standard care tasks are performed by the patients themselves, in principle without involvement of healthcare professionals, the latter being able to focus on complex conditions. This new vision on care will significantly reduce costs per patient while improving outcomes to enable long-term sustainability of top-level HF care.

Health Behavior and Health and Psychosocial Planning for Retirement among Spanish Health Professionals

The aging of the workforce among health professionals demands attention to the study of their health behavior before retirement. The aim of the present study is to analyze the relationships between health planning and psychosocial planning—on the one hand—and health professionals’ health behavior, on the other. In addition, we will study the mediator role of public protection, self-insurance, and self-protection in the relationship between planning and health behavior. The sample includes 169 healthcare professionals from a public hospital in Spain. A serial mediation model estimating all of the parameters simultaneously was tested. The findings have confirmed the relationship between health planning and health behavior, as well as the serial mediation of the behaviors in this relationship. As the main causes of death in the Western world are not transmittable diseases, but cardiovascular diseases, diabetes, and other diseases that are closely linked to lifestyle factors, our findings strongly support that we are responsible for our long-term health status and well-being.