Cost analysis of chronic heart failure management in Malaysia: A multi-centred retrospective study

Abstract

BackgroundEstimation of the economic burden of heart failure (HF) through a complete evaluation is essential for improved treatment planning in the future. This estimation also helps in reimbursement decisions for newer HF treatments. This study aims to estimate the cost of HF treatment in Malaysia from the Ministry of Health’s perspective.Materials and methodsA prevalence-based, bottom-up cost analysis study was conducted in three tertiary hospitals in Malaysia. Chronic HF patients who received treatment between 1 January 2016 and 31 December 2018 were included in the study. The direct cost of HF was estimated from the patients’ healthcare resource utilisation throughout a one-year follow-up period extracted from patients’ medical records. The total costs consisted of outpatient, hospitalisation, medications, laboratory tests and procedure costs, categorised according to ejection fraction (EF) and the New York Heart Association (NYHA) functional classification.ResultsA total of 329 patients were included in the study. The mean ± standard deviation of total cost per HF patient per-year (PPPY) was USD 1,971 ± USD 1,255, of which inpatient cost accounted for 74.7% of the total cost. Medication costs (42.0%) and procedure cost (40.8%) contributed to the largest proportion of outpatient and inpatient costs. HF patients with preserved EF had the highest mean total cost of PPPY, at USD 2,410 ± USD 1,226. The mean cost PPPY of NYHA class II was USD 2,044 ± USD 1,528, the highest among all the functional classes. Patients with underlying coronary artery disease had the highest mean total cost, at USD 2,438 ± USD 1,456, compared to other comorbidities. HF patients receiving angiotensin-receptor neprilysin-inhibitor (ARNi) had significantly higher total cost of HF PPPY in comparison to patients without ARNi consumption (USD 2,439 vs. USD 1,933, p < 0.001). Hospitalisation, percutaneous coronary intervention, coronary angiogram, and comorbidities were the cost predictors of HF.ConclusionInpatient cost was the main driver of healthcare cost for HF. Efficient strategies for preventing HF-related hospitalisation and improving HF management may potentially reduce the healthcare cost for HF treatment in Malaysia.

Primary causes and direct medical cost of heart failure among adults admitted with acute decompensated heart failure in a public tertiary hospital, Kenya

“…The cost of medications was the leading driver of the overall cost as has been evidenced in prior literature (41,42). The overall cost also expectedly increased with advanced NYHA (S Table 1), EF (S Table 2), comorbidities particularly (S Table S, and S Fig 1), and discharge status; overall cost of those who died was as twice as that of those who were discharged alive (S Table 3).…”

Financial burden of heart failure in Malaysia: A perspective from the public healthcare system

“…The current study estimated the economic burden of HF in Malaysia using cost data calculated from the bottom-up approach [ 25 ]. Unlike other studies in which the costs were derived from insurance claims [ 13 , 45 ] and hospital casemix database [ 50 ], the bottom-up approach can segregate the costs according to disease severities and other categories because detailed data was collected from each patient [ 51 ].…”

“…The methodology for estimating the direct cost of HF has been described in detail in the previous cost analysis study [ 25 ]. The study obtained ethical approval from the Ministry of Health Medical Research and Ethics Committee (NMRR-20-2379-56411(IIR)).…”

“…The population-level economic burden of HF was estimated based on LVEF and age categories. The economic burden of HF was calculated by multiplying the mean annual cost of HF derived from the cost analysis [ 25 ] by the population of chronic HF (categorised by LVEF and age categories). The mean annual costs of HF were stratified according to LVEF and age categories.…”

“…The previous cost analysis study focused on estimating the mean annual cost of HF by cost components for different HF phenotypes (categorised by LVEF), disease severities (categorised by New York Heart Association functional classification [NYHA]), and underlying comorbidities [ 25 ]. Subsequently, the main focus of the current study was to estimate the population-level economic burden of HF in Malaysia.…”