Direct and indirect costs, early retirement, cardiovascular events and mortality in more than 50,000 adults with chronic heart failure in Sweden: a matched case-control study
Authors: Carlsson K , Faurby M , Nilsson K , Wolden M L 
Published: October 2022

Abstract

Introduction
Chronic heart failure (CHF) is a progressive condition that requires long-term treatment for symptom management; it is associated with reduced physical functioning and quality of life, and increased mortality. Real-world data from population-based registries can be used to quantify CHF impact on both individuals and healthcare systems.

Purpose
To examine the progression of direct and indirect healthcare costs, cardiovascular (CV) outcomes and mortality over 5 years in people with CHF and matched controls in Sweden.

Methods
In this closed cohort study, adults (aged ≥18 years) living in Sweden on 1/1/2012 were identified in an existing database,1,2 and those with CHF (≥1 inpatient admission/outpatient visit with a main or sub-diagnosis of heart failure in the National Patient Register [1997–2011]) were propensity score matched to controls without CHF by birth year, sex and educational status. Study variables included costs of selected hospital-based care and prescription drugs, and mortality from the National Board of Health and Welfare; demographic and socioeconomic information from Statistics Sweden; and work absences from Försäkringskassan (Swedish Social Insurance Agency). We compared annual and cumulative direct healthcare costs (inpatient, outpatient and drug costs) and indirect costs from lost productivity, and analysed risks of stroke, myocardial infarction (MI), early retirement, and mortality.

Results
After matching, there were 53,520 individuals in each cohort. Demographic characteristics were well matched (Table). Over 5 years (2012–2016), cumulative direct costs for people with CHF were four- to fivefold higher than those for controls (2012: €5477/€971; 2013: €10 074/€1986; 2014: €14,009/€2976; 2015: €17 622/€3950; 2016: €20,723/€4942); cumulative indirect costs were at least 2.5 times higher (2012: €5419/€2144; 2013: €10,524/€4047; 2014: €15,215/€5735; 2015: €19,595/€7285; 2016: €23,732/€8646). In people with CHF, inpatient costs comprised 78% of total annual mean direct costs over follow-up (€3995/€5144). Outpatient costs contributed 15% (€763) and drug costs contributed 8% (€386) of total annual direct costs. In controls, these were 71% (€808), 18% (€209) and 11% (€124), respectively, of total annual mean direct costs (€1141). People with CHF were significantly more likely than controls to experience stroke (hazard ratio [HR]: 1.61 [95% confidence interval (CI): 1.51–1.71]) or MI (1.75 [1.65–1.87]). All-cause mortality was nearly threefold higher (2.89 [2.80–2.98]) and the risk of early retirement was nearly fourfold higher (3.79 [3.16–4.53]). During follow-up, 31.3% (n=16,766) of people in the CHF cohort died, compared with 10.1% (n=5426) of controls (Figure).

Conclusions
This analysis demonstrates the considerable impact of CHF, in terms of risk of CV events and death, early retirement and healthcare costs. Inpatient admissions and lost productivity were major contributors to economic costs.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This study was supported by a grant from Novo Nordisk A/S to the Swedish Institute for Health Economics. Medical writing support was provided by Oxford PharmaGenesis, Oxford, UK, with funding from Novo Nordisk A/S.