The Cost of Medical Management in Advanced Heart Failure During the Final Two Years of Life

Russo, Mark J.; Gelijns, Annetine C.; Stevenson, Lynne W.; Sampat, Bhaven; Aaronson, Keith D.; Renlund, Dale G.; Ascheim, Deborah D.; Hong, Kimberly N.; Oz, Mehmet C.; Moskowitz, Alan J.; Rose, Eric A.; Miller, Leslie W.; for the Rematch Investigators,

doi:10.1016/j.cardfail.2008.06.005

« Previous Next »Journal of Cardiac Failure
Volume 14, Issue 8 , Pages 651-658, October 2008

The Cost of Medical Management in Advanced Heart Failure During the Final Two Years of Life

Mark J. Russo, MD, MS
- Columbia University, New York, New York
Annetine C. Gelijns, PhD
- Columbia University, New York, New York
Lynne W. Stevenson, MD
- Brigham and Women's Hospital, Boston, Massachusetts
Bhaven Sampat, PhD
- Columbia University, New York, New York
Keith D. Aaronson, MD
- University of Michigan, Ann Arbor, Michigan
Dale G. Renlund, MD
- LDS Hospital, Salt Lake City, Utah
Deborah D. Ascheim, MD
- Columbia University, New York, New York
Kimberly N. Hong, MHSA
- Columbia University, New York, New York
Mehmet C. Oz, MD, MBA
- Columbia University, New York, New York
Alan J. Moskowitz, MD
- Columbia University, New York, New York
Eric A. Rose, MD
- Columbia University, New York, New York
Leslie W. Miller, MD
- Washington Hospital Center, Washington, DC
for the Rematch Investigators

Received 14 March 2008; received in revised form 27 May 2008; accepted 2 June 2008. published online 21 July 2008.

Abstract

Objective

To examine patterns of resource use and the cost of care for patients with advanced heart failure treated with medical management (MM) during the final 2 years of life.

Methods and Results

The study population (n=47, mean age 70.4 years±7.06) included patients randomized to the MM arm of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure trial. Inpatient and outpatient use data were obtained from the clinical dataset and Centers for Medicare and Medicaid Services (beginning January 1, 1998). Cost and resource use were tracked from the date of death (t_d) backward in 3-month intervals (eg, t_d-1, t_d-2). In the primary analysis, costs were summed across intervals. The mean cost of MM in the final 2 years of life was $156,169, with 50.5% ($78,880.39) expended in the final 6 months. The mean quarterly cost increased (P < .01) 4.9-fold from t_d-8 ($8,816 ± $14,270) to t_d-1 ($42,836 ± $41,407). The number of inpatient days increased (P < .01) 6.6-fold from 3.8±4.7 days to 22.2±23.5 days during the same time intervals.

Conclusion

This current economic analysis extends on previous findings by demonstrating that medical therapy in advanced and end-stage heart failure is associated with significant costs and resource consumption; these costs and resource consumption increase significantly as death approaches.

Key Words: Cost, heart failure, human, medical therapy, treatment outcomes

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Presented at the 2006 American Heart Association Scientific Sessions, November 12 to 15, 2006, Chicago, Illinois.

The REMATCH trial was supported, in part, by a cooperative agreement (HL-53986) funded by the National Heart Lung and Blood Institute of the National Institutes of Health, Bethesda, Maryland, and Thoratec Corporation, Pleasanton, California. Additional funding for the routine costs of clinical care associated with the trial was made available by the Center for Medicare and Medicaid Services and by the participating clinical centers. Reprint requests: Mark J. Russo, MD, MS, New York-Presbyterian Hospital/Columbia, Milstein Hospital Bldg, Room 7-435 GN, 177 Fort Washington Avenue, New York, NY 10032.

PII: S1071-9164(08)00180-2

doi:10.1016/j.cardfail.2008.06.005

« Previous Next »Journal of Cardiac Failure
Volume 14, Issue 8 , Pages 651-658, October 2008

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