土耳其心力衰竭疾病成本：基于德尔菲小组的直接和间接成本分析。
Cost-of-disease of Heart Failure in Turkey: A Delphi Panel-based Analysis of Direct and Indirect Costs.
机构信息
Department of Cardiology, Faculty of Medicine Eskisehir Osmangazi University, Eskişehir, Turkey
Department of Cardiology, Faculty of Medicine Başkent University, İstanbul, Turkey
出版信息
Balkan Med J. 2022 Jul 22;39(4):282-289. doi: 10.4274/balkanmedj.galenos.2022.2022-3-97.
BACKGROUND
Heart failure (HF) is considered a significant public health issue with a substantial and growing epidemiologic and economic burden in relation to longer life expectancy and aging global population.
AIMS
To determine cost-of-disease of heart failure (HF) in Turkey from the payer perspective.
STUDY DESIGN
Cross-sectional cost of disease study.
METHODS
In this cost-of-disease study, annual direct and indirect costs of management of HF were determined based on epidemiological, clinical and lost productivity inputs provided by a Delphi panel consisted of 11 experts in HF with respect to ejection fraction (EF) status (HF patients with reduced EF (HFrEF), mid-range EF (HFmrEF) and preserved EF (HFpEF)) and New York Heart Association (NYHA) classification. Direct medical costs included cost items on outpatient management, inpatient management, medications, and non-pharmaceutical treatments. Indirect cost was calculated based on the lost productivity due to absenteeism and presenteeism.
RESULTS
51.4%, 19.5%, and 29.1% of the patients were estimated to be HFrEF, HFmrEF, and HFpEF patients, respectively. The total annual direct medical cost per patient was $887 and non-pharmaceutical treatments ($373, 42.1%) were the major direct cost driver. Since an estimated nationwide number of HF patients is 1,128,000 in 2021, the total annual national economic burden of HF is estimated to be $1 billion in 2021. The direct medical cost was higher in patients with HFrEF than in those with HFmrEF or HFpEF ($1,147 vs. $555 and $649, respectively). Average indirect cost per patient was calculated to be $3,386 and was similar across HFrEF, HFmrEF and HFpEF groups, but increased with advanced NYHA stage.
CONCLUSION
Our findings confirm the substantial economic burden of HF in terms of both direct and indirect costs and indicate that the non-pharmaceutical cost is the major direct medical cost driver in HF management, regardless of the EF status of HF patients.
背景
心力衰竭（HF）被认为是一个重大的公共卫生问题，随着预期寿命的延长和全球人口老龄化，其在流行病学和经济方面的负担也在不断增加。
目的
从支付者的角度确定土耳其心力衰竭（HF）的疾病成本。
研究设计
横断面疾病成本研究。
方法
在这项疾病成本研究中，根据 11 名心力衰竭专家组成的德尔菲小组提供的流行病学、临床和生产力损失数据，确定了 HF 管理的年度直接和间接成本，这些数据与射血分数（EF）状态（射血分数降低的心力衰竭（HFrEF）、中间范围 EF（HFmrEF）和保留 EF（HFpEF））和纽约心脏协会（NYHA）分类有关。直接医疗费用包括门诊管理、住院管理、药物和非药物治疗的费用项目。间接成本是根据缺勤和在职缺勤造成的生产力损失计算的。
结果
估计 51.4%、19.5%和 29.1%的患者分别为 HFrEF、HFmrEF 和 HFpEF 患者。每位患者的年直接医疗费用为 887 美元，非药物治疗（373 美元，占 42.1%）是主要的直接费用驱动因素。由于 2021 年全国 HF 患者估计为 112.8 万人，2021 年 HF 的全国年度经济负担估计为 10 亿美元。HFrEF 患者的直接医疗费用高于 HFmrEF 或 HFpEF 患者（分别为 1147 美元、555 美元和 649 美元）。每位患者的平均间接费用估计为 3386 美元，在 HFrEF、HFmrEF 和 HFpEF 组之间相似，但随着 NYHA 阶段的进展而增加。
结论
我们的研究结果证实了 HF 在直接和间接成本方面的巨大经济负担，并表明无论 HF 患者的 EF 状态如何，非药物成本都是 HF 管理的主要直接医疗成本驱动因素。
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