Out-of-pocket (OOP) spending for patients with heart failure with reduced ejection fraction rose in the event of a worsening heart failure event across the 4 phases of Medicare Part D coverage.
According to published research, in 2020, heart failure–related costs were a median $24,383 per year, with expenses related to hospitalizations accounting for just over 65%, or $15,879, of that total. As recently as that year, 5 million individuals were living with congestive heart failure and new diagnoses accounted for another 500,000 cases.
In addition, the cost totals represent an increase. In 2017, patient-related costs for a heart failure hospitalization averaged $14,631.
Now, a new analysis presented at this year’s American College of Cardiology 70th Scientific Session breaks down heart failure–related costs again—but this time, among those enrolled in Medicare Part D who specifically have heart failure with reduced ejection fraction (HFrEF). This is when left ventricular ejection fraction is 40% or less.
“Studies have shown high clinical and economic burden in patients with HFrEF who experience a worsening heart failure event (WHFE), but Medicare Part D out-of-pocket costs (OOP) are not well characterized,” the investigators noted. “This study evaluated OOP drug spending in chronic HFrEF patients with and without a worsening heart failure event.
Overall, within 1 year after their earliest HFrEF diagnosis, 26% of the entire patient cohort (n = 80,454) had a WHFE. And although the mean (SD) overall OOP costs were already elevated, at $1166 ($1205), those who had a WHFE had to fork over close to 17% more in OOP costs compared with those who did not have a WHFE: $1302 ($1273) vs $1117 ($1176), respectively.
Beyond OOP, or deductible, costs, the authors investigated the 3 other phases of Part D Medicare coverage: the initial coverage period, the coverage gap (or donut hole), and catastrophic coverage.
Not surprisingly, mean OOP costs rose with each successive phase and were higher among those with a WHFE vs those with no WHFE and overall, respectively:
The analysis also found fluctuating claims levels in each Medicare coverage phase. Just over one-third of the patients overall and in the WHFE and non-WHFE groups had a claim in the deductible phase (34.5%, 33.3%, and 34.9%, respectively). However, these numbers spiked in the initial coverage phase (93.3%, 95.2%, 92.6%) before dropping once again in the coverage gap (39.2%, 44.3%, 37.3%) and catastrophic (10.8%, 12.9%, 10.1%) phases.
For their analysis, the authors used 2018 Medicare 100% Part D fee-for-service claims data on patients with HFrEF and 12 months of enrollment in 2018 (N = 305,373). They defined the heart failure subtype as each participant having “1 inpatient or 2 outpatient claims of systolic heart failure or 1 systolic heart failure plus 1 heart failure outpatient claim.”
Different criteria were used to gauge a WHFE and comprised hospitalization for heart failure or need for an intravenous diuretic by the 12-month mark after receiving their HFrEF diagnosis.
“The findings suggest a high OOP cost burden in patients with chronic HFrEF,” the authors concluded, “especially in those following a WHFE.”
Reference
Fendrick M, Djatche L, Pulungan Z, et al. Part D out of pocket payments in Medicare beneficiaries with heart failure with reduced ejection fraction. Presented at: American College of Cardiology’s 70th Scientific Session; May 15-17, 2021. Virtual. Abstract 1038-07. https://www.abstractsonline.com/pp8/#!/9228/presentation/12576
Study Highlights Significant Increases in Utilization, Spending on DMD Drugs in Medicaid
May 17th 2024The findings add to recent research on the growing utilization, expenditure, and prices of Duchenne muscular dystrophy (DMD) therapies in the current landscape, an area health care policy could potentially address.
Read More
Frameworks for Advancing Health Equity: Urban Health Outreach
May 9th 2024In the series debut episode of "Frameworks for Advancing Health Equity," Mary Sligh, CRNP, and Chelsea Chappars, of Allegheny Health Network, explain how the Urban Health Outreach program aims to improve health equity for individuals experiencing homelessness.
Listen
Panel Addresses Minority Physician Shortage, Maternal Health at Senate Committee Hearing
May 15th 2024The senate hearing held by the US Senate Committee on Health, Education, Labor, and Pensions, led by Sen. Bernie Sanders (I, Vermont), chairman of the committee, and ranking member Sen. Bill Cassidy, MD, (R, Louisiana), addressed the critical issue of physician and health care worker shortages, as well as the maternal health crisis, in the US.
Read More
Oncology Onward: A Conversation With Thyme Care CEO and Cofounder Robin Shah
October 2nd 2023Robin Shah, CEO of Thyme Care, which he founded in 2020 with Bobby Green, MD, president and chief medical officer, joins hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, to discuss his evolution as an entrepreneur in oncology care innovation and his goal of positively changing how patients experience the cancer system.
Listen
Bleeds and Resource Use in Hemophilia B: Retrospective Observational Study
May 15th 2024This real-world US study describes individuals with hemophilia B who experience bleeds despite factor replacement therapy and quantifies the associated comorbidity and health care resource utilization burden.
Read More
A new study highlights significant disparity in reimbursement rates across states between hospitals and Medicare; the first patient to receive a genetically modified pig kidney has died; research examines outcomes of over 500 patients receiving medication abortion pills by mail.
Read More