The cost impact to Medicare of shifting treatment of worsening heart failure from inpatient to outpatient management settings

Abstract

PurposeThe aim of this study was to quantify the potential cost savings to Medicare of shifting the site of treatment for worsening heart failure (HF) from inpatient to outpatient (OP) settings for a subset of worsening HF episodes among the Medicare fee-for-service (FFS) population.Materials and methodsA cross-sectional analysis of a random 5% sample of 2014 FFS Medicare beneficiaries was conducted. Incidence and cost of worsening HF episodes in both inpatient and OP settings were identified. These results were used to calculate cost savings associated with shifting a proportion of worsening HF episodes from the inpatient to OP settings.ResultsA total of 151,908 HF beneficiaries were identified. The estimated annual cost for the treatment of worsening HF across both inpatient and OP settings ranged from US$9.3 billion to US$17.0 billion or 2.4%–4.3% of total Medicare FFS spend. The cost saving associated with shifting worsening HF treatment from inpatient hospital setting to OP settings was US$667.5 million or 0.17% of total Medicare spend when 10% of HF admissions were targeted and 60% of targeted HF admissions were successfully shifted. The cost savings increased to US$2.098 billion or 0.53% of total Medicare spend when 20% of HF admissions were targeted and 90% of targeted HF admissions were successfully shifted.ConclusionTreatment options that can shift costly hospital admissions for worsening HF treatment to less expensive OP settings potentially lead to significant cost savings to Medicare. Pursuit of OP therapy options for treating worsening HF might be considered a viable alternative.

A Systematic Review of Medical Costs Associated with Heart Failure in the USA (2014–2020)

“…Five studies (5/87) used an economic model populated with data from different healthcare databases [ 45 , 52 – 56 ]. A cross-sectional design, where costs were assessed at a discrete point in time, was adopted by three studies [ 57 – 59 ]. The remaining two studies used information generated alongside a randomized controlled trial [ 33 , 46 ].…”

“…Thus, the perspective of analysis was often based on the researchers’ interpretation of the data. In 40 (45%) studies [ 22 – 24 , 44 , 46 , 47 , 49 , 50 , 53 , 55 , 57 , 58 , 60 – 86 ], costs for HF-related events were (or appeared to have been) analyzed from a payer’s perspective. Three studies adopted a healthcare sector perspective [ 87 – 89 ].…”

“…The earliest cost year used in the studies was 2009 [ 24 ], with the latest cost year being 2017 [ 57 ]. Forty-four studies did not report a price year for cost estimates.…”

“…Two studies estimated the average post-discharge cost following a HF hospitalization event [ 57 , 97 ]. The average 30-day post-discharge cost following a worsening HF admission was estimated at $6283 per patient [ 57 ].…”

“…Two studies estimated the average post-discharge cost following a HF hospitalization event [ 57 , 97 ]. The average 30-day post-discharge cost following a worsening HF admission was estimated at $6283 per patient [ 57 ]. It was calculated as the difference between all costs incurred in the 30 days following discharge and the average 1-month cost of a patient with HF [ 57 ].…”