The Cost of Medical Management in Advanced Heart Failure During the Final Two Years of Life

Objective: To examine patterns of resource use and the cost of care for patients with advanced heart failure treated with medical management (MM) during the final 2 years of life. Methods and Results: The study population (n = 47, mean age 70.4 years ± 7.06) included patients randomized to the MM arm of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure trial. Inpatient and outpatient use data were obtained from the clinical dataset and Centers for Medicare and Medicaid Services (beginning January 1, 1998). Cost and resource use were tracked from the date of death (t_d) backward in 3-month intervals (eg, t_d-1, t_d-2). In the primary analysis, costs were summed across intervals. The mean cost of MM in the final 2 years of life was $156,169, with 50.5% ($78,880.39) expended in the final 6 months. The mean quarterly cost increased (P < .01) 4.9-fold from t_d-8 ($8,816 ± $14,270) to t_d-1 ($42,836 ± $41,407). The number of inpatient days increased (P < .01) 6.6-fold from 3.8 ± 4.7 days to 22.2 ± 23.5 days during the same time intervals. Conclusion: This current economic analysis extends on previous findings by demonstrating that medical therapy in advanced and end-stage heart failure is associated with significant costs and resource consumption; these costs and resource consumption increase significantly as death approaches.