Cost Effective to Society for Heart Failure Treatment
Beta blocker therapy for the treatment of heart failure can provide significant cost savings for the health-care system, according to a new analysis by researchers at the Duke Clinical Research Institute (DCRI).
Beta blocker therapy reduced societal costs by $3,959 per patient over five years, the study showed. However, while the costs to Medicare declined by $6,064 per patient, the cost to the individual patient increased by $2,113 over five years because Medicare currently does not cover the cost of prescription medications. Congress enacted a Medicare prescription drug benefit in November 2003, but this will not take full effect until 2006. Even then, beneficiaries in many cases will still pay a significant amount of the cost of prescription medications.
The study, published in the Jan. 15, 2004, issue of The American Journal of Medicine, was funded by a grant from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, to the Duke Center for Education and Research on Therapeutics.
The study developed a model of heart failure progression over five years. The authors used clinical trial data to establish the effect of beta blockers on mortality and hospitalizations. Estimates of hospital costs were obtained from the Duke University Medical Center, and physician fees were based on the Medicare fee schedule. The data was used to assess the economic effects of beta blocker therapy for heart failure patients from societal, Medicare, hospital, physician and patient perspectives.
"Our study suggests beta blocker therapy is both clinically and financially beneficial over the long term from a societal standpoint," said Robert Califf, M.D., senior author of the study and director of DCRI. "The clinical benefit of beta blockers is unquestioned. The issue here is that hospitals and physicians have no clear financial incentives to support increased beta blocker use. Changes in practice patterns could be encouraged, however, by linking reimbursement with evidenced-based care and covering patients' medication costs."
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The annual treatment costs for heart failure in the United States totals more than $6 billion. Heart failure is a condition in which the heart's muscle becomes weakened after it is injured following a heart attack or from high blood pressure, and loses its ability to pump enough blood. According to the Heart Failure Society of America, it affects nearly 5 million Americans with an estimated 400,000 to 700,000 new cases diagnosed each year. About 250,000 Americans die annually from heart failure.
The number of patients living with heart failure is increasing because of improved rates of survival following heart attacks and more effective treatments. Beta-blockers reduce heart rate and blood pressure by blocking the stimulatory effects of epinephrine and norepinephrine and are primarily used to help treat high blood pressure, chest pain and heartbeat irregularities. However, less than half of these patients use beta blockers despite studies showing improved outcomes, Califf said.
The study showed that expenditures for a heart failure patient not receiving beta-blockers during a five-year period total $52,999 and survival is typically 3.6 years. Patients receiving beta-blocker therapy have a total cost of $49,040 and a survival of 3.9 years. Most of the savings were realized from a decrease in inpatient cost, from $37,294 to $29,697 -- or a savings of $7,597 per patient. Outpatient costs for patients receiving beta blockers increased by $1,183, rising from $12,817 during the five-year period to $14,000. Medication costs for those on beta blockers increased by $2,455, rising from $2,888 to $5,343.
"Of the perspectives considered, Medicare would gain the most if heart failure patients were treated with beta blockers," said Califf. "Under current policy the program could realize savings from reduced hospitalizations without incurring the expense of beta blockers." However, the researchers suggest that if Medicare supported interventions that increased beta blocker use, patient outcomes could be improved at little or no additional expense. "Savings would persist even if beta blockers were completely covered by Medicare," Califf said.
The researchers noted that physician and hospital revenues would decrease with broader use of beta blockers due to lower hospitalization rates and increased medication titration and symptom management. "Hospitals have no financial incentive to reduce heart failure readmissions if these admissions generate at least as much net revenue as other hospitalizations. In this situation, providing reimbursement for improved discharge prescribing patterns could motivate hospitals to encourage physicians to optimize discharge medications," Califf said.
"Without additional resources, physicians may not be able to alter their practice patterns in a way that increases the demands on their time brought about by broader beta blocker usage. Additional funding for outpatient management, such as coverage of clinical pharmacist services, could remove financial barriers to improving prescribing patterns," he added. Joining Califf in the study were Duke colleagues Patricia Cowper, Ph.D., Elizabeth DeLong, Ph.D., David Whellan, M.D., and Nancy Allen LaPointe, PharmD.
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