Diagnostic and lifetime hospital costs of patients suffering from wild-type transthyretin amyloid cardiomyopathy in Denmark

Abstract

Aims: Wild-type transthyretin amyloid cardiomyopathy (ATTRwt) is a fast progressing and fatal disease associated with substantial delays in diagnosis. Between the first symptoms and diagnosis, patients are frequently hospitalized, primarily with cardiac symptoms. After diagnosis, patients continue to experience frequent hospital admissions. The objective of this study was to estimate the Danish diagnostic and lifetime hospital costs associated with the treatment of patients with ATTRwt both before and after they are diagnosed. Materials and Methods: We developed a cost model for Danish hospital costs associated with ATTRwt, including the costs of diagnosis, cardiac implants, and hospital admissions covering inpatient hospitalization and outpatient hospital care (ambulatory and emergency services). The number of diagnoses, cardiac implants, inpatient hospitalization and outpatient hospital care were estimated based on published data. Estimates of the unit costs were based on publicly available Danish reference costs. We calculated the total hospital costs covering the median lifespan of patients from onset of symptoms, which is 13 months prior to diagnosis, to 52 months after diagnosis which is the median survival time after diagnosis. Results: The average cost of diagnosing ATTRwt was USD 3,424 per patient; the average costs of cardiac implants were USD 1,851 per patient. Hospital admissions costs totaled USD 3,345 pre-diagnosis and USD 59,449 post-diagnosis per patient, on average. The total diagnostic and lifetime (65 months) hospital costs associated with ATTRwt were USD 68,069. Conclusions: Caring for patients with ATTRwt places a significant economic burden on the healthcare system. The study emphasizes the cost saving potential for medical interventions in this patient population.

Estimating the health benefits of timely diagnosis and treatment of transthyretin amyloid cardiomyopathy

“…This cycling through different investigations and services would be largely avoided with prompt diagnosis. An economic evaluation by Pilgaard et al of diagnostic and lifetime hospital costs of patients with ATTRwt-CM in the Danish healthcare setting concluded that healthcare resource use costs could be reduced through earlier diagnosis [39].…”

Healthcare resource use of patients with transthyretin amyloid cardiomyopathy

“…Although the epidemiology of ATTR‐CM is beginning to emerge in published research using register data, 8,11–13 treatment patterns for ATTR‐CM patients and their healthcare resource use are not well documented. There is a large body of work on the humanistic and economic burden of heart failure from around the world, 14–16 but only few studies on the healthcare resource use of ATTR‐CM 17–19 .…”

“…Although the epidemiology of ATTR‐CM is beginning to emerge in published research using register data, 8,11–13 treatment patterns for ATTR‐CM patients and their healthcare resource use are not well documented. There is a large body of work on the humanistic and economic burden of heart failure from around the world, 14–16 but only few studies on the healthcare resource use of ATTR‐CM 17–19 . Existing studies have been limited to modelled resource use based on data collected from peer‐reviewed journal articles, claims data covering only part of the country population, self‐reported resource use, and did not compare resource use of ATTR‐CM patients to that of a relevant population such as general HF patients not diagnosed with ATTR‐CM.…”

Detecting transthyretin amyloid cardiomyopathy (ATTR-CM) using machine learning: an evaluation of the performance of an algorithm in a UK setting

“…ATTRwt is a condition that is often underdiagnosed and misdiagnosed leading to diagnostic delay 2 6. As such, patients, their families and healthcare services may incur increased burden during extended contact associated with diagnostic investigations 22 27 28. Furthermore, delays in ATTRwt diagnosis are associated with more advanced disease at diagnosis 27 29.…”