Treatment charges and resource use among patients with heart failure enrolled in an MCO

Gregory De Lissovoy, Marc Zodet, Karen Coyne, John B. O'Connell

Research output: Contribution to journalArticlepeer-review

Abstract

The purpose of this study was to determine patient-level annual expenditures and resource use for heart failure (HF) and change in annual expenditure after a hospital admission for HF. The study population comprised members of an IPA-model MCO (N = 899) who were 40 to 74 years old and continuously enrolled for at least six months before and after an index hospital admission with a primary diagnosis of HF. A retrospective analysis was conducted of administrative claims data between 1996 and 1998. Analysis was stratified by five-year age groups and by quintiles created by rank-ordering individuals according to their pre-index annualized expenditure and then dividing the cohort into five equal groups. During the year before the index HF event, median annualized charges were $6,026 (mean ± SD, $17,490 ± $32,234), and median postevent charges were $14,292 (mean, $35,780 ± $60,881), a 98% increase in median (105% increase in mean). Age was unrelated to average annual expenditure or to increase in expenditure after the index event. One-year readmission rates ranged from 30% (95% confidence interval [CI], 35%-51%), for patients in the least costly quintile, to 63% for the most costly quintile (95% CI, 55%-71%). Although HF prevalence increases with age, patient-level treatment expenditures are comparable across age groups. Hospital admission for HF is associated with a substantial increase in treatment intensity and annual expenditure.

Original languageEnglish (US)
Pages (from-to)46-52
Number of pages7
JournalManaged Care Interface
Volume15
Issue number5
StatePublished - 2002
Externally publishedYes

ASJC Scopus subject areas

  • Health Policy

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