Cause-Specific Health Care Costs Following Hospitalization for Heart Failure and Cost Offset With SGLT2i Therapy

Veraprapas Kittipibul; Muthiah Vaduganathan; Uchechukwu Ikeaba; Karen Chiswell; Javed Butler; Adam D DeVore; Paul A Heidenreich; Joanna C Huang; Michelle M Kittleson; Karen E Joynt Maddox; Karthik K Linganathan; James J McDermott; Anjali Tiku Owens; Pamela N Peterson; Scott D Solomon; Orly Vardeny; Clyde W Yancy; Gregg C Fonarow; Stephen J Greene

doi:10.1016/j.jchf.2024.04.003

Cause-Specific Health Care Costs Following Hospitalization for Heart Failure and Cost Offset With SGLT2i Therapy

JACC Heart Fail. 2024 Apr 6:S2213-1779(24)00268-3. doi: 10.1016/j.jchf.2024.04.003. Online ahead of print.

Authors

Veraprapas Kittipibul¹, Muthiah Vaduganathan², Uchechukwu Ikeaba³, Karen Chiswell³, Javed Butler⁴, Adam D DeVore¹, Paul A Heidenreich⁵, Joanna C Huang⁶, Michelle M Kittleson⁷, Karen E Joynt Maddox⁸, Karthik K Linganathan⁶, James J McDermott⁶, Anjali Tiku Owens⁹, Pamela N Peterson¹⁰, Scott D Solomon¹¹, Orly Vardeny¹², Clyde W Yancy¹³, Gregg C Fonarow¹⁴, Stephen J Greene¹⁵

Affiliations

¹ Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University School of Medicine, Durham, , North Carolina, USA.
² Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
³ Duke Clinical Research Institute, Durham, North Carolina, USA.
⁴ Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA; Baylor Scott and White Research Institute, Dallas, Texas, USA.
⁵ Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.
⁶ AstraZeneca, Wilmington, Delaware, USA.
⁷ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁸ Cardiology Division, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
⁹ Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁰ Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA; Department of Medicine, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.
¹¹ Division of Cardiology, Duke University School of Medicine, Durham, , North Carolina, USA.
¹² Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System and University of Minnesota, Minneapolis, Minnesota, USA.
¹³ Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
¹⁴ Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, Los Angeles, California, USA.
¹⁵ Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University School of Medicine, Durham, , North Carolina, USA. Electronic address: stephen.greene@duke.edu.

PMID: 38727651
DOI: 10.1016/j.jchf.2024.04.003

Abstract

Background: Little is known regarding differences in cause-specific costs between heart failure (HF) with ejection fraction (EF) ≤40% vs >40%, and potential cost implications of sodium glucose co-transporter 2 inhibitor (SGLT2i) therapy.

Objectives: This study sought to compare cause-specific health care costs following hospitalization for HF with EF ≤40% vs >40% and estimate the cost offset with implementation of SGLT2i therapy.

Methods: This study examined Medicare beneficiaries hospitalized for HF in the Get With The Guidelines-Heart Failure registry from 2016 to 2020. Mean per-patient total (excluding drug costs) and cause-specific costs from discharge through 1-year follow-up were calculated and compared between EF ≤40% vs >40%. Next, risk reductions on total all-cause and HF hospitalizations were estimated in a trial-level meta-analysis of 5 pivotal trials of SGLT2is in HF. Finally, these relative treatment effects were applied to Medicare beneficiaries eligible for SGLT2i therapy to estimate the projected cost offset with implementation of SGLT2i, excluding drug costs.

Results: Among 146,003 patients, 50,598 (34.7%) had EF ≤40% and 95,405 (65.3%) had EF >40%. Mean total cost through 1 year was $40,557. Total costs were similar between EF groups overall but were higher for EF ≤40% among patients surviving the 1-year follow-up period. Patients with EF >40% had higher costs caused by non-HF and noncardiovascular hospitalizations, and skilled nursing facilities (all P < 0.001). Trial-level meta-analysis of the 5 SGLT2i clinical trials estimated 11% (rate ratio: 0.89; 95% CI: 0.84-0.93; P < 0.001) and 29% (rate ratio: 0.71; 95% CI: 0.66-0.76; P < 0.001) relative reductions in rates of total all-cause and HF hospitalizations, respectively, regardless of EF. Reductions in all-cause and HF hospitalizations were projected to reduce annual costs of readmission by $2,451 to $2,668 per patient with EF ≤40% and $1,439 to $2,410 per patient with EF >40%.

Conclusions: In this large cohort of older U.S. adults hospitalized for HF, cause-specific costs of care differed among patients with EF ≤40% vs >40%. SGLT2i significantly reduced the rate of HF and all-cause hospitalizations irrespective of EF in clinical trials, and implementation of SGLT2i therapy in clinical practice is projected to reduce costs by $1,439 to $2,668 per patient over the 1 year post-discharge, excluding drug costs.

Keywords: SGLT2 inhibitor; cost; heart failure; hospitalization.