Cor Vasa 2018, 60(3):e224-e233 | DOI: 10.1016/j.crvasa.2018.03.002

Chronic heart failure - Impact of the condition on patients and the healthcare system in the Czech Republic: A retrospective cost-of-illness analysis

Marie Pavlušová^a,b, Jiří Klimeš^c,d, Jindřich Špinar^a,b, Kamil Zeman^e, Jiří Jarkovský^f, Klára Benešová^g, Roman Miklík^a,b, Ludmila Pohludková^e, Marián Felšöci^a,b, Věra Veselá^c, Michaela Blahovcová^c, Filip Dostál^c, Richard Vonka^c, Jiří Pařenica^a,b,*

^a Interní kardiologická klinika, Fakultní nemocnice Brno, Brno, Česká republika

^b Lékařská fakulta Masarykovy univerzity, Brno, Česká republika

^c Novartis, s.r.o, Česká republika

^d Farmaceutická fakulta Univerzity Karlovy, Hradec Králové, Česká republika

^e Interní oddělení, Nemocnice ve Frýdku-Místku, p.o., Frýdek-Místek, Česká republika

^f Institut biostatistiky a analýz, Lékařská fakulta Masarykovy univerzity, Brno, Česká republika

Background: The number of patients with heart failure is steadily increasing, as are the costs of their treatment. Nearly 70% of the costs associated with the treatment of heart failure are direct medical costs, and 70-80% of these are spent on hospitalizations. The aim of our study is to describe the all-cause hospitalization costs of patients with chronic heart failure (chronic HF) from the perspective of the healthcare system in the Czech Republic.

Methods: In total, 1274 consecutively collected patients discharged in a stable condition from hospitalization for acute heart failure (= index hospitalization) from 2006 to 2012 were followed-up for 2 years. Their all-cause mortality and all-cause hospitalizations were retrospectively evaluated. The in-patient costs were calculated based on the relative weights of DRG codes for particular hospitalization events and on the basic DRG tariff for 2013 (CZK 28,898).

Results: At the end of the 2-year follow-up, a total of 1511 hospitalizations were recorded. A total of 31.8% of patients survived without any hospitalization, 32.1% of patients survived with at least one hospitalization, and 36.1% of patients died. Re-hospitalizations for acute heart failure accounted for 31.2% of all cases. The average cost for one chronic HF patient hospitalized for any reason was CZK 85,414; the cost for acute heart failure re-hospitalization was CZK 31,320 during the 2-year follow-up period. The cost of all-cause hospitalizations within the first year after the index hospitalization was higher compared to the cost during the second year (CZK 58,528/year vs CZK 23,082/year). As the estimated number of chronic HF patients is 230,000 (data from the Institute of Health Information and Statistics of the Czech Republic), we can calculate the total cost of all-cause hospitalizations of chronic HF patients to be approximately CZK 7.98 billion per year in the Czech Republic.

Conclusion: The data from clinical practice confirm that patients with chronic HF discharged from acute heart failure hospitalization are at high risk of death and/or subsequent hospitalization. The average annual costs for all-cause hospitalizations of CHF patients within the first and second years are CZK 58,528 and CZK 23,082 per patient, respectively. The costs attributed to all-cause hospitalization care of chronic HF patients can be estimated as approximately 7.7% of all annual inpatient expenses of health insurance companies and 2.7% of total healthcare expenditures in the Czech Republic.

Keywords: Cost-of-illness; Chronic heart failure; Hospitalization costs

Received: February 16, 2018; Accepted: March 6, 2018; Published: June 1, 2018  Show citation