Heart Failure Treatment Can Increase Healthcare Expenses
Heart failure affects 6.2 million American adults and is implicated in more than 370,000 deaths each year. It costs the nation more than $30 billion a year, according to CDC data.1
By 2030, 8 billion people will be diagnosed with heart failure in the United States. The annual cost of caring for these patients is close to $30,000, mostly for inpatient care.2
The results of a recent review reveal the economic burden of heart failure for patients and the healthcare system is increasing due to high costs of hospitalization/rehospitalizations and chronic treatments.2
“As our population ages, this burden of heart failure is just going to grow,” says Paul A. Heidenreich, MD, MS, lead review author and professor and vice chair for quality in the department of medicine at Stanford University.
New Treatments Come at Hefty Price
Hospitalizations are expensive, but so are new treatments. “In the last 15 years or so, we’ve had an increase in new treatments that, while beneficial, also are costly,” he says. “A classic example is the drug tafamidis.”
Tafamidis is approved for cardiomyopathy due to transthyretin (TTR) amyloidosis. It can improve some heart failure patients’ survival and quality of life, but its wholesale cost is $225,000 per year.2
“That’s one example of the new treatments that are increasing the cost of treating patients with heart failure,” Heidenreich says.
Heidenreich and colleagues set out to study the cost-effectiveness of new treatments. “Would they pay for themselves if they keep people out of the hospital?” he asks.
Investigators found the new treatments typically do not pay for themselves. The cost of the treatments was so high that even with hospitalization decreased, the cost was still higher than any savings.
“Yes, they typically increased survival,” Heidenreich says. “That is how the cost-effectiveness studies measure the benefits.”
For example, with tafamidis, the incremental cost-effectiveness ratio is $880,000 per quality-adjusted life year (QALY).
Sometimes, the cost of treatment is paid by the hospital, which receives one lump payment for certain conditions and hospitalizations. “They don’t get paid per individual treatment; just one lump sum,” Heidenreich explains.
The healthcare system can do more to maintain quality care and reduce costs. Some tactics are outlined in guidelines by the American College of Cardiology and the American Heart Association.2
Guidelines May Help
The two associations adopted the World Health Organization’s recommendation of adjusting the threshold for value using the wealth of society, measured by the gross domestic product (GDP). In the United States, this means a treatment is considered high value if the cost per QALY gained is less than one GDP per capita, which was $65,000 in 2019. If the cost per QALY is over three GDP/capita, its value is considered poor, the guidelines suggested.
“The guidelines typically don’t consider the cost of care when making recommendations, but they will say if one therapy is better than another,” Heidenreich says. “They’ll point that out and give a higher recommendation.”
These same calculations can be used for cancer and other illnesses with high treatment costs.
“As these costs go up, all payers have to make decisions: ‘Do we stop coverage for certain things?” he says. “Often, prevention is what does not get covered.”
Or, payers could raise the premiums so everyone’s healthcare costs are higher. In the case of Medicare, taxpayers cover the rising costs.
“It’s a real issue that payers have to deal with. Ultimately, all of us have to deal with it since we pay premiums or taxes,” Heidenreich says.
With the focus on population health and case management to improve the efficiency and success of care transitions, health systems and providers should focus on using treatments that are effective and not expensive.
“Prices of treatment should be proportional to the benefit,” Heidenreich explains. “Society should think about how much is reasonable to pay to improve a year of life, and then tell companies that if your drug only provides a small benefit, then you need to lower your prices.”
Also, preventive care should be a higher priority. With heart failure patients, signs in lab tests and imaging can suggest a person’s heart is not functioning normally, even if the patient is not experiencing symptoms.
“There are some pretty inexpensive treatments that could be used in that population, such as ACE inhibitors and beta-blockers, that could help prevent the onset of symptoms,” Heidenreich adds.
Primary care providers could assess patients for heart disease risk factors through a screening test, including an ECG.
“Some studies suggest that if a person is at significantly high risk, the screening test would be worth the small cost,” Heidenreich notes. “We need more studies before we make a strong recommendation.”
But clinicians already have use showing that people with diabetes, with high blood pressure, and those who smoke are at risk for heart failure.
Healthcare providers can take measures to put heart failure patients on less expensive treatments. For example, providers can create a dashboard of guideline-recommended treatments and determine which patients are candidates for these treatments and whether they are receiving them.
“Taking the population health approach, they can reach out to either the patient’s primary care provider or the cardiologist and ask why they are not being treated with these recommended treatments,” Heidenreich suggests. “Some groups are trying to do this with pharmacists — having them take that role because it takes a fair number of interactions, including video interactions, to get people titrated to the recommended doses. That also takes a lot of physician time.”
Assigning this role to pharmacists or advanced practice providers is good for health systems, Heidenreich adds.
REFERENCES
- Centers for Disease Control and Prevention. Heart failure. Updated Sept. 8, 2020.
- Heidenreich PA, Fonarow GC, Opsha Y, et al. Economic issues in heart failure in the United States. J Card Fail 2022;28:453-466.
Heart failure affects 6.2 million American adults and is implicated in more than 370,000 deaths each year. It costs the nation more than $30 billion a year, according to CDC data. By 2030, 8 billion people will be diagnosed with heart failure in the United States. The annual cost of caring for these patients is close to $30,000, mostly for inpatient care. The results of a recent review reveal the economic burden of heart failure for patients and the healthcare system is increasing due to high costs of hospitalization/rehospitalizations and chronic treatments.
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