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

Escobar, Carlos; Palacios, Beatriz; Varela, Luis; Gutiérrez, Martín; Duong, Mai; Chen, Hungta; Justo, Nahila; Cid-Ruzafa, Javier; Hernández, Ignacio; Hunt, Phillip R.; Delgado, Juan

doi:10.1186/s12913-022-08614-x

Cited by 18 publications

(17 citation statements)

References 64 publications

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“…The management of patients with HF with mildly reduced or preserved ejection fraction is a significant economic burden on healthcare systems, with the long-term costs of HF with preserved ejection fraction thought to be greater than those of HFrEF. 37 The cost of hospitalization is a driver of this expenditure, 38,39 whereby a reduced risk of clinical events may ameliorate this economic burden. The model results indicate that dapagliflozin reduced the incidence of HHF, UHFV and CV deaths versus usual care.…”

Section: Discussionmentioning

confidence: 99%

The cost‐effectiveness of dapagliflozin in heart failure with preserved or mildly reduced ejection fraction: A European health‐economic analysis of the DELIVER trial

Booth

Davis

McEwan

et al. 2023

European J of Heart Fail

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AimsTo determine the cost‐effectiveness of dapagliflozin, added to usual care, in patients with heart failure (HF) with mildly reduced or preserved ejection fraction for the UK, German and Spanish payers using detailed patient‐level data from the Dapagliflozin Evaluation to Improve the LIVEs of Patients with Preserved Ejection Fraction Heart Failure (DELIVER) trial.Methods and resultsA lifetime Markov state‐transition cohort model was developed. Quartiles of the Kansas City Cardiomyopathy Questionnaire total symptom score (KCCQ‐TSS) defined health states and monthly transition count data informed transition probabilities. Multivariable generalized estimating equations captured the incidence of HF hospitalizations and urgent HF visits, while cardiovascular deaths and all‐cause mortality were estimated using adjusted parametric survival models. Health state costs were assigned to KCCQ‐TSS quartiles (2021 British pound [GBP]/Euro) and patient‐reported outcomes were sourced from DELIVER. Future values of costs and effects were discounted according to country‐specific rates. In the UK, dapagliflozin treatment was predicted to increase quality‐adjusted life years (QALYs) and life‐years by 0.231 and 0.354, respectively, and extend the time spent in the best quartile of KCCQ‐TSS by 4.2 months. Comparable outcomes were projected for Germany and Spain. The incremental cost‐effectiveness ratios were £7761, €9540 and €5343/QALY in the UK, Germany and Spain, respectively. According to regional willingness‐to‐pay thresholds, 91%, 89% and 92% of simulations in the UK, Germany and Spain, respectively, were cost‐effective following probabilistic sensitivity analyses.ConclusionDapagliflozin, added to usual care, is very likely cost‐effective for HF with mildly reduced or preserved ejection fraction in several European countries.

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Section: Discussionmentioning

confidence: 99%

The cost‐effectiveness of dapagliflozin in heart failure with preserved or mildly reduced ejection fraction: A European health‐economic analysis of the DELIVER trial

Booth

Davis

McEwan

et al. 2023

European J of Heart Fail

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“…This may be related to the clinical setting that patients attend, as well as reflecting geographic differences. Thus, patients of cardiologists are usually younger and have higher rates of HFrEF than patients of internal medicine departments, who are usually older and more likely to have HFpEF [ 11 , 12 , 13 , 14 , 19 ]. The BIG-PAC database collects information from integrated and computerized medical records from both inpatient and primary care [ 13 , 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, patients of cardiologists are usually younger and have higher rates of HFrEF than patients of internal medicine departments, who are usually older and more likely to have HFpEF [ 11 , 12 , 13 , 14 , 19 ]. The BIG-PAC database collects information from integrated and computerized medical records from both inpatient and primary care [ 13 , 14 , 15 ]. Our data provide a more balanced and comprehensive picture of the Spanish population newly diagnosed with HF.…”

Section: Discussionmentioning

confidence: 99%

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Burden of Illness beyond Mortality and Heart Failure Hospitalizations in Patients Newly Diagnosed with Heart Failure in Spain According to Ejection Fraction

Cervantes

Palacios

González

et al. 2023

JCM

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Objective: The objective of this study was to describe the rates of adverse clinical outcomes, including all-cause mortality, heart failure (HF) hospitalization, myocardial infarction, and stroke, in patients newly diagnosed with HF to provide a comprehensive picture of HF burden. Methods: This was a retrospective and observational study, using the BIG-PAC database in Spain. Adults, newly diagnosed with HF between January 2013 and September 2019 with ≥1 HF-free year of enrolment prior to HF diagnosis, were included. Results: A total of 19,961 patients were newly diagnosed with HF (43.5% with reduced ejection fraction (EF), 26.3% with preserved EF, 5.1% with mildly reduced EF, and 25.1% with unknown EF). The mean age was 69.7 ± 19.0 years; 53.8% were men; and 41.0% and 41.5% of patients were in the New York Heart Association functional classes II and III, respectively. The baseline HF treatments included beta-blockers (70.1%), renin–angiotensin system inhibitors (56.3%), mineralocorticoid receptor antagonists (11.8%), and SGLT2 inhibitors (8.9%). The post-index incidence rates of all-cause mortality, HF hospitalization, and both combined were 102.2 (95% CI 99.9–104.5), 123.1 (95% CI 120.5–125.7), and 182 (95% CI 178.9–185.1) per 1000 person-years, respectively. The rates of myocardial infarction and stroke were lower (26.2 [95% CI 25.1–27.4] and 19.8 [95% CI 18.8–20.8] per 1000 person-years, respectively). Conclusions: In Spain, patients newly diagnosed with HF have a high risk of clinical outcomes. Specifically, the rates of all-cause mortality and HF hospitalization are high and substantially greater than the rates of myocardial infarction and stroke. Given the burden of adverse outcomes, these should be considered targets in the comprehensive management of HF. There is much room for improving the proportion of patients receiving disease-modifying therapies.

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“…1,2 Moreover, health care costs associated with HF are enormous, being HF hospitalizations the most important determinant. 5,6 Patients with chronic HF may deteriorate, either suddenly or slowly, and require hospital admission or treatment with intravenous diuretic therapy in the outpatient setting. These periods of decompensation represent an inflexion point in the evolution of patients as they indicate that HF is progressing, with a greater risk of adverse events, particularly death and HF hospitalization.…”

Section: Introductionmentioning

confidence: 99%

Role of vericiguat in management of patients with heart failure with reduced ejection fraction after worsening episode

Olivella,

Almenar‐Bonet,

Moliner

et al. 2023

ESC Heart Failure

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Worsening heart failure (HF) is a vulnerable period in which the patient has a markedly high risk of death or HF hospitalization (up to 10% and 30%, respectively, within the first weeks after episode). The prognosis of HF patients can be improved through a comprehensive approach that considers the different neurohormonal systems, with the early introduction and optimization of the quadruple therapy with sacubitril–valsartan, beta‐blockers, mineralocorticoid receptor antagonists, and inhibitors. Despite that, there is a residual risk that is not targeted with these therapies. Currently, it is recognized that the cyclic guanosine monophosphate deficiency has a negative direct impact on the pathogenesis of HF, and vericiguat, an oral stimulator of soluble guanylate cyclase, can restore this pathway. The effect of vericiguat has been explored in the VICTORIA study, the largest chronic HF clinical trial that has mainly focused on patients with recent worsening HF, evidencing a significant 10% risk reduction of the primary composite endpoint of cardiovascular death or HF hospitalization (number needed to treat 24), after adding vericiguat to standard therapy. This benefit was independent of background HF therapy. Therefore, optimization of treatment should be performed as earlier as possible, particularly within vulnerable periods, considering also the use of vericiguat.

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

Cited by 18 publications

References 64 publications

The cost‐effectiveness of dapagliflozin in heart failure with preserved or mildly reduced ejection fraction: A European health‐economic analysis of the DELIVER trial

The cost‐effectiveness of dapagliflozin in heart failure with preserved or mildly reduced ejection fraction: A European health‐economic analysis of the DELIVER trial

Burden of Illness beyond Mortality and Heart Failure Hospitalizations in Patients Newly Diagnosed with Heart Failure in Spain According to Ejection Fraction

Role of vericiguat in management of patients with heart failure with reduced ejection fraction after worsening episode

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