Pharmacoeconomic analysis of costs related to cardiac surgery in patients hospitalized for acute heart failure

Abstract

Aim: To assess the direct costs of hospitalization in connection with management of patients undergoing cardiac surgery and initially hospitalized at a department of cardiology for acute heart failure (AHF) from the perspective of the health care payer; a detailed analysis of the proportion of comprehensive management of heart failure by cardiac surgery (including surgical revascularization, treatment of heart valve disease, and perioperative management of atrial fibrillation by cryoablation) in total costs incurred during hospitalization related to management of AHF. Methods: Out of a total of 1,357 patients hospitalized between 2005 and 2007 in the Department of Internal Medicine/Cardiology (DIMC) of Brno University Hospital for AHF, 63 patients (4.6%) were scheduled for early surgical revascularization by coronary artery bypass grafting and/or surgical treatment of heart valve disease after transfer from the DIMC. In indicated cases, cryoablation for atrial fibrillation was peformed perioperatively. Direct costs included clinical tests on admission to DIMC, transfer to the Department of Cardiac Surgery, and tests on discharge, hospitalization days, medication, separately charged drugs and materials, and diagnostic and therapeutic procedures. The evaluation covered the costs incurred in connection with hospitalization in the DIMC for AHF, costs for stay in the Department of Cardiac Surgery including surgery itself and overall hospitalization costs. Costs incurred in 2005, 2006, and 2007 were compared statistically. Results: Overall, data of the 63 patients (79.4% of males, mean age 68.3 years) were analyzed; 46 patients had new-onset AHF, 17 patients presented with acute decompensation of chronic heart failure. Total hospital stay length was 25 days (median), with average costs being 361,565 CZK/patient (approx. 14,000 EUR). There was a significant increase in total hospital stay length (median 23.5, 23.5, and 31 days) and a significant rise in total costs (266,344; 328,591; and 510,000 CZK; approx. 10,250; 12,600; and 19,600 EUR, respectively) over the years 2005 through 2007. A detailed analysis revealed an association between the increase in costs related to cardiac surgery and the severity of heart failure requiring comprehensive management by cardiac surgery and prolonged stay at the intensive care unit (ICU). Five patients spent all their hospitalization time in DIMC and Department of Cardiac and Transplant Surgery (DCTS) (median 20 days) exclusively at the ICU while the remaining patients spent 10 days at the ICU (DIMC and DCTS altogether) and 16 days in standard ward. Hospitalization in DCTS for AHF accounted for 14% of total costs (median stay length 11 days, average hospitalization-related costs including tests and procedures amounted to 50,784 CZK; approx. 1,950 EUR), with the remaining costs related to hospitalization and surgery in DCTS (median 15 days, average total hospitalization costs 310,781 CZK; approx. 11,950 EUR). Conclusions: Acute heart failure is a life-threatening condition with a variety of causes and complications. The most effective long-term method of treatment of heart failure for coronary heart disease is revascularization by percutaneous coronary intervention or coronary artery bypass grafting. Comprehensive treatment of heart failure by cardiac surgery includes additional critical and life-extending procedures such as, in particular, surgical management of heart valve disease and treatment of atrial fibrillation by cryoablation. This comprehensive management by cardiac surgery is most costly; in our series of patients, the average total costs of hospitalization of a single patient were as high as 361,565 CZK (approx. 14,000 EUR).