The Economic Burden of Heart Failure
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1 The Economic Burden of Heart Failure Davos February 13, 2013 Thomas D. Szucs University of Basel 1
2 Overview of this lecture Today: The burden of heart failure Tomorrow What will it bring? What can we afford? 2 2
3 Burden A burden is a heavy weight that is difficult to carry. Metaphorically it refers to anything difficult or troubling. Daumier, Honoré ( ) The Burden 3
4 Economic burden of disease 4
5 The Heart Failure Complex presents itself in many facets 5
![Direct hospital costs of heart failure mainly relate to the costs of inpatient hospital stays Medical costs of heart failure ( millions) Cost of HF [ ] millions (2006) % of total Total direct cost 2](/docs-images/84/91183428/images/6-0.jpg "879 100 Outpatient (including physician, OPD, pharmacies, medical practice and other outpatient facilities) 784 27 Inpatient total 1 721 60% Inpatient hospital stay 1 304 45% Emergency service 57 21")
6 Direct hospital costs of heart failure mainly relate to the costs of inpatient hospital stays Medical costs of heart failure ( millions) Cost of HF [ ] millions (2006) % of total Total direct cost Outpatient (including physician, OPD, pharmacies, medical practice and other outpatient facilities) Inpatient total % Inpatient hospital stay % Emergency service Physician visit Distribution of direct cost of HF, 2006 (%) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 6% 21% 60% 27% Cost of Heart Failure (%) Physician visit Emergency service Inpatient total Outpatient (including physician, OPD, pharmacies, medical practice and other outpatient facilities) In 2006, the diagnosis of heart failure led to a cost to the German public health system of 2.9 billion. Direct hospital costs of heart failure ( 1.3 billion in Germany in 2006) mainly relate to the costs of inpatient hospital stays. Dtsch Arztebl Int 2009; 106(16):
7 Patients with specified events and risk for events within 28 days and 1 year of the index admission Robertson et al. BMC Health Services Research 2012, 12:103 14
8 Mean length of stay in days for index admission and readmissions Robertson et al. BMC Health Services Research 2012, 12:103 15
9 Kaplan-Meier curves for time to heart failure readmission and time to any readmission Robertson et al. BMC Health Services Research 2012, 12:103 16
10 Kaplan-Meier curves for time to death for each 5 year age group for patients over 45 year of age Robertson et al. BMC Health Services Research 2012, 12:103 17
11 Vilfredo Pareto,
12 Distribution of costs of patients with AHF in hospital ITT Group Standard-of-care; REVIVE II Study De Lissovoy G et al. Eur J Health Econ 2010; 11:
13 High cost cases (HCC) in Switzerland Average net payments (CHF) per case in diagnostic group per year, averages '000 50'000 45'201 40'000 30'000 20'000 10'000 21'045 20'092 18'453 14'186 14'118 10'068 9'841 8'156 7'954 7' '482 7'237 Source: Engler, (database: CSS sample western Switzerland
14 Cases in % High cost cases (HCC) in Switzerland Average number of cases of diagnostic groups per year, average No HCC All HCC Source: Engler, (database: CSS sample western Switzerland
15 Cost weight % High cost cases (HCC) in Switzerland Cost weight of diagnostic groups per year, average No HCC All HCC Source: Engler, (database: CSS sample western Switzerland
16 Diagnosis-related groups (DRGs) F62A F62B F62C Heart failure and shock with extremely severe complications, with dialysis or CPR or complicating diagnosis Heart failure and shock with extremely severe complications, without dialysis, without CPR, without complicating diagnosis Heart failure and shock without extremely severe complications Swiss DRG Catalogue Version
17 Diagnosis-related groups (DRGs) Code Description Average length of stay (days) Lower marginal length of stay (days) Upper marginal length of stay (days) F62A F62B F62C Heart failure and shock with extremely severe complications, with dialysis or CPR or complicating diagnosis Heart failure and shock with extremely severe complications, without dialysis, without CPR, without complicating diagnosis Heart failure and shock without extremely severe complications Swiss DRG Catalogue Version
18 DRG-based estimate of acute heart failure cases in Switzerland DRG # cases CaseMix CaseMix-Index Baserate (CHF) Costs (CHF)/case Total cases (CHF) F62A 773 1' '139 12'475'761 F62B 1'900 2' '246 23'268'287 F62C 10'928 9' '926 86'617'172 Benchmark Baserate AMC: 9533 CHF Benchmark Baserate non AMC: 8721 CHF Helsana Insurance Group, own calculations (M. Früh) 28
19 Costs of CRT in Switzerland in 2011 (Helsana Insurance) CHOP 00.50_CRT-P Complete system 00.51_CRT-D Complete system 00.53_CRT-P Only pulse generator 00.54_CRT-D Only pulse generator Age group # cases CM CMI calculated Baserate (CHF) Costs (CHF) LOS total ALOS ' ' ' ' ' ' '086 1'857' '086 1'545' '086 36' '086 1'925' '086 3'599' '086 5'345' '086 5'041' ' ' '086 86' '086 4' ' ' ' ' ' ' '086 32' ' ' ' ' '086 1'788' '086 1'915' ' ' Helsana Insurance Group, own calculations (M. Früh) Total: CHF 27'418'319 29
20 Cardiovascular morbidity costs in Switzerland 2011 (Helsana Insurance) Age group Cardiac medication costs Concomitant Medication costs In-patient Costs Outpatient Costs Total '413'293 55'772'656 36'150'612 68'316' '653' '733'428 74'803'214 51'781'846 79'898' '217' '281' '148' '240' '346' '016' '848' '499' '532' '717' '598' '864'648 94'277' '915'012 98'247' '305' '771'116 13'835'411 19'324'120 12'420'562 48'351'209 Total 98'912' '337' '945' '947'841 1'678'142'581 Helsana Insurance Group, own calculations (M. Früh) 30
21 The future What will it bring? 48
22 Most important determinants of future burden Babyboomers
23 Projected total (direct and indirect) costs of all CVD by age, 2010 to 2030 (in billion 2008$). Heidenreich PA et al
24 Projections of Crude CVD Prevalence (%), in the United States Heidenreich PA et al
25 Projected Direct (Medical) Costs of CVD, (in Billions 2008$) in the United States Heidenreich PA et al
26 Projected Indirect (Lost Productivity) Costs of CVD, (in Billions 2008$) in the United States Heidenreich PA et al
27 Most important determinants of future burden Costly technologies
28 What about prevention? Morbidity costs Prevention costs
29 Leveraging morbidity costs through prevention 57
30 Preventive measures are available for most underlying conditions of HF Nieminnen MS et al. Eur Heart J
31 Role of health plans 64
32 PAYMENT METHODOLODY Evolving care models and reimbursement Evolving Reimbursement and Care Models Full Capitation Sub- Capitation Case Rates P4P (Robust) P4P ( Lite ) EMR Evolution of Supporting Systems Registries Closed System *Team-Based Care *Disease Management Fee-for- Service Non-MD Clinicians Solo MD Practices Group Practices Multi-Specialty Group Practices Integrated Delivery System Clinic Model Thomas Lee STAGE OF EVOLUTION 14 66
33 A general question remains Which services shall be financed out of solidarity? 67 67
34 Acknowledgments Helsana Department of Health Sciences P. Gyger Dr O. Reich M. Früh ECPM PD Matthias Schwenkglenks Dr Patricia Blank Dr Florian Gutzwiller Dr Klazien Matter MA Alena Pfeil 68
35 Questions? 69
36 Contact Thomas D. Szucs, MD MBA MPH LLM Director; Professor of Medicine Institute of Pharmaceutical Medicine European Center of Pharmaceutical Medicine Klingelbergstrasse 61 CH-4056 Basel T F E W thomas.szucs@unibas.ch
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