Fitch Kathryn, Lau Jocelyn, Engel Tyler, Medicis Joseph J, Mohr John F, Weintraub William S
Milliman Inc., New York, NY, USA,
scPharmaceuticals Inc., Burlington, MA, USA.
Clinicoecon Outcomes Res. 2018 Dec 14;10:855-863. doi: 10.2147/CEOR.S184048. eCollection 2018.
The aim of this study was to quantify the potential cost savings to Medicare of shifting the site of treatment for worsening heart failure (HF) from inpatient to outpatient (OP) settings for a subset of worsening HF episodes among the Medicare fee-for-service (FFS) population.
A cross-sectional analysis of a random 5% sample of 2014 FFS Medicare beneficiaries was conducted. Incidence and cost of worsening HF episodes in both inpatient and OP settings were identified. These results were used to calculate cost savings associated with shifting a proportion of worsening HF episodes from the inpatient to OP settings.
A total of 151,908 HF beneficiaries were identified. The estimated annual cost for the treatment of worsening HF across both inpatient and OP settings ranged from US$9.3 billion to US$17.0 billion or 2.4%-4.3% of total Medicare FFS spend. The cost saving associated with shifting worsening HF treatment from inpatient hospital setting to OP settings was US$667.5 million or 0.17% of total Medicare spend when 10% of HF admissions were targeted and 60% of targeted HF admissions were successfully shifted. The cost savings increased to US$2.098 billion or 0.53% of total Medicare spend when 20% of HF admissions were targeted and 90% of targeted HF admissions were successfully shifted.
Treatment options that can shift costly hospital admissions for worsening HF treatment to less expensive OP settings potentially lead to significant cost savings to Medicare. Pursuit of OP therapy options for treating worsening HF might be considered a viable alternative.
本研究的目的是量化对于医疗保险计划（Medicare）按服务付费（FFS）人群中一部分病情恶化的心力衰竭（HF）患者，将治疗地点从住院转为门诊（OP）所可能节省的费用。
对2014年FFS Medicare受益人的5%随机样本进行横断面分析。确定住院和门诊环境中病情恶化的HF发作的发生率和费用。这些结果用于计算将一部分病情恶化的HF发作从住院环境转移到门诊环境所节省的费用。
共识别出151,908名HF受益人。住院和门诊环境中治疗病情恶化的HF的估计年度费用在93亿美元至170亿美元之间，占Medicare FFS总支出的2.4% - 4.3%。当针对10%的HF入院病例且60%的目标HF入院病例成功转移时，将病情恶化的HF治疗从住院医院环境转移到门诊环境所节省的费用为6.675亿美元，占Medicare总支出的0.17%。当针对20%的HF入院病例且90%的目标HF入院病例成功转移时，节省的费用增加到20.98亿美元，占Medicare总支出的0.53%。
能够将用于治疗病情恶化的HF的昂贵住院治疗转移到费用较低的门诊环境的治疗选择，有可能为Medicare节省大量费用。寻求用于治疗病情恶化的HF的门诊治疗选择可能被认为是一种可行的替代方案。
