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Direct costs of heart failure in a portuguese population.
1Hospital Funchal, Internal Medicine - Funchal - Portugal
2Heart Failure Unit, Hospital de Sao Francisco Xavier, Lisbon, Portugal, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa - Lisbon - Portugal
3NOVA University Lisbon, NOVA National School of Public Health - Lisbon - Portugal
Introduction: Heart failure (HF) is a global public health issue. Its economic impact in the Autonomous Region of Madeira (ARM) is unknown. Due to the condition’s high prevalence and healthcare utilization, profiling its costs is fundamental for improved disease management. Purpose: To estimate the direct costs related to HF in the ARM. Methods: A prevalence-based cost-of-illness approach was adopted to estimate direct costs of heart failure over a 12 month period from the healthcare system perspective. Prevalence estimates were derived from previous published study. Hospitalization and emergency department (ED) episodes were identified by the International Classification of Diseases 9th edition. Patterns of ambulatory visits and diagnostic tests in the hospital and primary care setting were derived from previous reported research and regional health system data. Medication use was also derived from this study. Costs were based on Diagnosis Related Groups and from the Portuguese official national health system tariffs. Results: There was a 4.93% prevalence of HF in 2014 in individuals aged above 25 years, equivalent to an estimated 9201 patients. Of these, 4140 were symptomatic (NYHA=II) and hence considered healthcare consumers. We identified 426 admissions with primary diagnosis of HF, 5.5% of total cardiovascular admissions. There were 16850 primary care ambulatory visits, 857 ED visits and 13414 internal medicine and cardiology ambulatory visits. Total direct costs were €4,089,540. Hospital-related care summed 56% of total costs, of which 49% related to hospitalization. Primary care costs accounted for 22%, medication (20%) and long term care (2%). Average annual cost per patient was €987.81. Conclusion: Total costs amounted to 0.1% of gross domestic product and 1.2% of the healthcare budget of the ARM. This finding is in line with other reports from developed countries. HF is a costly syndrome for ARM, and this research adds information about the disease that was until now unknown. Population ageing is likely to continue to drive increasing costs. These results can help policy making by identifying the financial burden of HF for the healthcare public provider in the ARM. Since it defined several cost components, this study can aid in the implementation of measures to improve disease management in the regional setting and reduce the major driver of costs which is hospitalization.
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