Costs Associated with Symptomatic Systolic Heart Failure
MEMO (Medicines Monitoring), University Department of Clinical Pharmacology, Ninewells Hospital & Medical School, Dundee, Scotland. PharmacoEconomics
(Impact Factor: 2.45).
11/1999; 16(4):399-407. DOI: 10.2165/00019053-199916040-00007
To investigate whether the extent of systolic dysfunction is a useful predictor of the costs of healthcare and social support for patients with heart failure.
Cross-sectional study with collection of cost data attributed to management of heart failure in the previous year.
Four primary-care practices in Scotland.
Patients receiving long term therapy with loop diuretics for suspected heart failure.
Two-dimensional and Doppler echocardiography.
Two hypotheses were tested: (i) the proportion of patients incurring costs is higher in patients with abnormal left ventricular (LV) function; and (ii) the median cost per patient that incurs costs is higher in patients with abnormal LV function. Of the 226 patients in the study, 67 (30%) had abnormal systolic function. In comparison with the remaining 159 patients, they had higher healthcare costs [560 Pounds vs 440 Pounds per patient year (1994/1995 values)], were more likely to incur hospital inpatient or outpatient costs [Odds ratio (OR): 2.02; 95% confidence interval (CI): 1.06 to 3.84] and had significantly higher primary-care costs (mean 292 Pounds vs 231 Pounds per patient year; p = 0.02, Mann Whitney test). In contrast, they were no more likely to incur social support costs (OR: 1.22; 95% CI: 0.52 to 2.86) and the mean cost of social support per patient year was lower (234 Pounds vs 373 Pounds).
Patients with objectively measured systolic dysfunction incurred significantly higher healthcare costs in the year before diagnosis. This suggests that treatment that improves systolic function will reduce healthcare costs, even in a primary-care population with relatively mild congestive heart failure.
Available from: nih.gov
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ABSTRACT: Therapeutic strategies centered on the cardiovascular system are important for the management of critically ill patients, especially in acute heart failure or in sepsis. Economic analysis of those strategies are increasingly demanded because of financial restrictions in our health care system. However, valid data based on comprehensive economic investigations are scarce in medical literature. Thrombolytic therapy after acute myocardial infarction and angiotensin-converting enzyme blockers proved to have desirable cost—benefit ratios. Coronary revascularization by percutaneous transluminal coronary angioplasty is substantially more expensive than medical therapy but significantly less expensive than coronary artery bypass graft surgery, and was found to be reasonably cost-effective in different groups of patients. Coronary stents and implantable cardioverter-defibrillators are relatively new and expensive methods and only the latter have demonstrated a clear economic benefit. Because of the complex outcome, variables in septic patients’ full economic evaluations are difficult to perform. Currently, only one detailed cost analysis is available.
Available from: Bruce R. Schatz
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ABSTRACT: The health care system has traditionally focused on treating disease at the point of failure, such as life-saving surgery or intensive medical therapy. As demographics shift more to an aging population, management of health-related quality of life and life-restricting disease becomes more necessary. Prominent among such diseases is congestive heart failure, which must be addressed as a major chronic health condition with its consequent effect on quality of life. This paper examines the methods of monitoring the quality of life in congestive heart failure. Particular attention is paid to congestive heart failure-related questionnaires to derive lifestyle information directly from patients. Comparison is made with general quality of life instruments. Most commonly, these questionnaires are applied to small populations in limited situations. New technology, such as the Internet, has greatly expanded the breadth and depth of health monitors by tracking status directly in patients' homes. This promises new levels of population management for heart disease. (c)2001 by CHF, Inc.
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