Identifying and Characterizing Commercially Insured HFpEF Patients with High vs. Low Healthcare Resource Utilization

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) represents half of all heart failure (HF) diagnoses and is a growing public health concern. Despite therapeutic advancements, HFpEF contributes to substantial HF-related healthcare utilization and costs. Further investigation to characterize these measures and identify potential associations is needed.Objective: The objectives of this study were to characterize the differences in healthcare resource utilization and costs among the top 90th and bottom 10th percentiles of total healthcare costs, examine the association between patient characteristics at diagnosis and the odds of being in the 90th percentile, and to examine the differences in utilization and costs over time between the high- and low-cost groups. Methods: We conducted a retrospective cohort study using data from the Merative™ MarketScan® Research Database, including commercially insured adults diagnosed with HFpEF between 2014 and 2021. Baseline characteristics, healthcare utilization, and costs were analyzed, and multivariable logistic regression was used to assess factors associated with higher costs. Healthcare resource use and costs over one-year follow-up were estimated using a Kaplan-Meier Sample Average (KMSA) with bootstrapping. Results: There were 24,078 HFpEF patients included in the study. High-cost patients exhibited significantly greater healthcare resource utilization, with an incremental average of 12 ED/urgent care visits, 3 inpatient admissions, and 29 days of hospital stay per year. Mean total annual costs for the 90th percentile was $363,092 while the 10th percentile was $1,710 per year. Baseline characteristics associated with higher odds of being in the high-cost group included female sex with a 1.13 (95% CI: 1.1, 1.2) times higher than males; and Charlson Comorbidity Index (CCI) scores; when comparing to the lowest CCI score found (one), a CCI score of two was associated with a 3.27 (OR: 3.0, 3.6) times increase in the odds, and a CCI score greater than two was associated with a 18.71 (OR: 16.8, 20.8) times increase in the odds of belonging to the 90th percentile. Comorbidities associated with higher odds of being in the high-cost group included atrial fibrillation (AF) with a 3.54 (95% CI : 2.8, 4.4) times increase in odds. The drug classes that increased the odds of belonging to the 90th percentile were loop diuretics with a 2.18 (95% CI: 2.0, 2.4) times increase in odds, ARNI with a 1.89 (95% CI : 1.1, 3.1) time increase in odds, and SGLT2i with a 4.48, (95% CI : 3.0, 6.7) times increase in odds. Factors associated with a decrease in the odds of being in the high-cost group included: diabetes mellitus with a 0.53 (95% CI: 0.4, 0.7) times decrease in the odds, hypertension with a 0.71 (95% CI: 0.6, 0.8) times decrease in the odds, and chronic kidney disease with 0.62 (95% CI :0.4, 0.9) times decrease in the odds of being in the 90th percentile. Conclusion: Significant incremental differences in healthcare utilization and costs exist between high-cost and low-cost HFpEF patients, indicating an opportunity for improvement. Identifying and addressing factors associated with higher costs at diagnosis could improve outcomes and reduce healthcare expenditures. Future real-world-evidence studies should focus on the impact of integrating SGLT2 inhibitors in clinical practice, and more clinical research is needed to determine the impact of this new discovery in managing AF in HFpEF patients.