Whellan David J, Greiner Melissa A, Schulman Kevin A, Curtis Lesley H
Center for Clinical and Genetic Economics, Duke University School of Medicine, Durham, NC, USA.
Circ Cardiovasc Qual Outcomes. 2010 Jan;3(1):33-40. doi: 10.1161/CIRCOUTCOMES.109.854760. Epub 2009 Nov 10.
Inpatient care is the primary driver of costs for patients with heart failure. It is unclear whether recent advances in heart failure care have reduced the costs to Medicare for the care of inpatients with heart failure.
In a retrospective cohort study of 1 363 977 elderly Medicare beneficiaries hospitalized with heart failure between January 1, 2001, and December 31, 2004, we examined costs to Medicare for all inpatient care, inpatient cardiovascular care, and inpatient heart failure care and the adjusted relationships between patient characteristics and costs. Among 1 363 977 Medicare beneficiaries with an index heart failure hospitalization, 901 885 (66%) had a subsequent inpatient claim during the following year. Noncardiovascular costs accounted for 57% of total inpatient costs, and costs associated with heart failure hospitalizations accounted for 15% of total inpatient costs. No significant changes occurred in total, cardiovascular, and heart failure inpatient costs over time.
The costs of inpatient care for patients with heart failure are high, but most subsequent inpatient costs are attributable to noncardiovascular and non-heart failure admissions. Further research is needed to identify predictors of costs, so that patients can be stratified according to risk, and to evaluate strategies that target primary cost drivers for patients with heart failure.
住院治疗是心力衰竭患者费用的主要驱动因素。目前尚不清楚心力衰竭治疗方面的最新进展是否降低了医疗保险用于心力衰竭住院患者治疗的费用。
在一项对2001年1月1日至2004年12月31日期间因心力衰竭住院的1363977名老年医疗保险受益人的回顾性队列研究中，我们研究了医疗保险用于所有住院治疗、住院心血管治疗和住院心力衰竭治疗的费用，以及患者特征与费用之间的校正关系。在1363977名首次因心力衰竭住院的医疗保险受益人中，901885人（66%）在次年有后续住院索赔。非心血管费用占住院总费用的57%，与心力衰竭住院相关的费用占住院总费用的15%。随着时间的推移，住院总费用、心血管费用和心力衰竭住院费用均未发生显著变化。
心力衰竭患者的住院治疗费用很高，但大多数后续住院费用归因于非心血管和非心力衰竭住院。需要进一步研究以确定费用的预测因素，以便根据风险对患者进行分层，并评估针对心力衰竭患者主要费用驱动因素的策略。
