The economic burden of congestive heart failure in a managed care population

Objective: To examine the economic burden of and treatment patterns for con gestive heart failure (CHF) in a managed care population. Study Design: Retrospective review of medical and pharmacy claims. Patients and Methods: We reviewed integrated medical and pharmacy claims da ta from 6 independent-practice-association model health maintenance organiz ations to identify patients diagnosed with CHF. Of the approximately 1.4 mi llion people enrolled in these managed care plans during the study period ( January through December 1994), a total of 2777 patients (mean age, 56.9 ye ars) met the study criteria, which included diagnostic codes for CHF and cl aims eligibility of at least 1 year. We reviewed the charges incurred by pa tients diagnosed with CHF for the 6 months after the initial CHF medical cl aim. We also examined the treatment received by each of these patients. Results: During the study period, 378 of the 2777 patients with CHF (14%) w ere admitted to the hospital at a cost of almost $3 million tan average of $7863 per hospitalized patient). Seventy-eight percent of the study populat ion received prescription drugs, at an average per-patient cost of $942. Th e most commonly prescribed drug class was angiotensin-converting enzyme inh ibitors, prescribed for 38% of patients. Calcium channel blockers were pres cribed for 33% of patients, but beta-blockers were prescribed for only 18% of patients. Hospitalization accounted for 54% of the total cost for CHF tr eatment, with prescription drugs accounting for 38%. Conclusion: Congestive heart failure represents a significant financial bur den within a non-elderly managed care population. Improved management of th e condition is needed to reduce the morbidity and mortality, as well as the costs of treatment, associated with CHF. Considerable data indicate that d rugs such as beta-blockers and angiotensin-converting enzyme inhibitors can significantly decrease the morbidity and mortality of CHF. Further investi gation is needed into whether increased use of prescription pharmaceuticals may reduce hospitalization rates and overall costs for CHF in this setting .