Campbell JA (Houston HSR&D)
Yu H (Houston HSR&D)
Moffett M (Houston HSR&D)
Petersen NJ (Houston HSR&D)
Henderson LM (Houston HSR&D)
Espadas D (Houston HSR&D)
Deswal A (Houston HSR&D)
Johnson M (Houston HSR&D)
To describe the cost of care in veterans with chronic heart failure (CHF) by examining the relationship between pharmacy, inpatient and ambulatory costs.
The study population was an outpatient-based cohort of all CHF patients identified through the FY97-FY02 National Patient Care Databases, linked to the FY00-FY02 Decision Support System National Data Extracts (DSS NDEs) for inpatient, ambulatory, and pharmacy costs. We computed a patient level cost and relative cost share for each of the three categories. To adjust for illness burden and distinguish cohort effects from changes in practice patterns, we stratified patients into groups based on the number of years since entry into the cohort. We then compared relative shares of costs between the groups over time.
The number of patients ranged from 286,410 in FY00 to 336,761 in FY02, and total costs of care ranged from a mean of $10,572 per patient to $10,216. In FY02, 20.9% of patients were hospitalized, however inpatient costs accounted for 48.1% of total CHF patient costs, while ambulatory costs were 38.3% and pharmacy costs were 13.6%. Among first year entrants into the FY02 cohort, the respective shares were 54.1%, 34.7%, and 11.2%, compared to shares of 47.4%, 39.0% and 13.6% for patients in the cohort for five years. Recent entrants into the cohort experienced sharper declines in the relative share of inpatient costs and increases in ambulatory and pharmacy costs during the first two years of care; the effect is lessened in years beyond.
: Inpatient costs comprise 48.1% of the cost of care for CHF patients in FY02, but include only 20.9% of the CHF population. From FY00- FY02, patients with CHF are increasingly shifted away from inpatient care and towards outpatient and pharmacological management.
CHF is a prevalent and resource intensive condition, and shifting resources towards ambulatory and pharmacological care may result in substantial cost savings. From FY00-FY02 there is a decline in per patient costs that represent a total savings over $90 million in this population.