Hollingworth William, Biswas Mousumi, Maishman Rachel L, Dayer Mark J, McDonagh Theresa, Purdy Sarah, Reeves Barnaby C, Rogers Chris A, Williams Rachael, Pufulete Maria
School of Social and Community Medicine, University of Bristol, Bristol, UK.
School of Social and Community Medicine, University of Bristol, Bristol, UK.
Int J Cardiol. 2016 Dec 1;224:132-138. doi: 10.1016/j.ijcard.2016.09.021. Epub 2016 Sep 15.
Evidence on the economic impact of heart failure (HF) is vital in order to predict the cost-effectiveness of novel interventions. We estimate the health system costs of HF during the last five years of life.
We used linked primary care and mortality data accessed through the Clinical Practice Research Datalink (CPRD) to identify 1555 adults in England who died with HF in 2012/13. We used CPRD and linked Hospital Episode Statistics to estimate the cost of medications, primary and hospital healthcare. Using GLS regression we estimated the relationship between costs, HF diagnosis, proximity to death and patient characteristics.
In the last 3months of life, healthcare costs were £8827 (95% CI £8357 to £9296) per patient, more than 90% of which were for inpatient or critical care. In the last 3months, patients spent on average 17.8 (95% CI 16.8 to 18.8) days in hospital and had 8.8 (95% CI 8.4 to 9.1) primary care consultations. Most (931/1555; 59.9%) patients were in hospital on the day of death. Mean quarterly healthcare costs in quarters after HF diagnosis were higher (£1439; [95% CI £1260 to £1619]) than in quarters preceding diagnosis. Older patients and patients with lower comorbidity scores had lower costs.
Healthcare costs increase sharply at the end of life and are dominated by hospital care. There is potential to save money by implementation and evaluation of interventions that are known to reduce hospitalisations for HF, particularly at the end of life.
心力衰竭（HF）经济影响的证据对于预测新干预措施的成本效益至关重要。我们估算了生命最后五年中HF的卫生系统成本。
我们使用通过临床实践研究数据链（CPRD）获取的关联初级保健和死亡率数据，以识别2012/13年在英格兰死于HF的1555名成年人。我们使用CPRD和关联的医院 Episode 统计数据来估算药物、初级和医院医疗保健的成本。使用广义最小二乘法回归，我们估算了成本、HF诊断、接近死亡程度和患者特征之间的关系。
在生命的最后3个月，每位患者的医疗保健成本为8827英镑（95%置信区间为8357英镑至9296英镑），其中超过90%用于住院或重症监护。在最后3个月，患者平均住院17.8天（95%置信区间为16.8至18.8天），并进行了8.8次（95%置信区间为8.4至9.1次）初级保健会诊。大多数（931/1555；59.9%）患者在死亡当天住院。HF诊断后各季度的平均季度医疗保健成本高于诊断前各季度（1439英镑；[95%置信区间为1260英镑至1619英镑]）。老年患者和合并症评分较低的患者成本较低。
医疗保健成本在生命末期急剧增加，且以医院护理为主。通过实施和评估已知可减少HF住院率的干预措施，尤其是在生命末期，有可能节省资金。
