PCV19Evaluation of The Costs of Heart Failure in Belgium

OBJECTIVE: To calculate the cost of heart failure in Belgium, based on an epidemiological model. METHODS: We applied a state transition model to simulate the disease progression of heart failure over a period of 5 years, taking into account a weighted average of current practice. Costs related to current practice (1996 values) and disease progression were taken from the perspective of the health insurance. Unit costs of ambulatory care were collected through official listings; hospitalization costs for heart failure were collected from a database of 58 hospitals (ICD codes 402, 428, 429). Current practice was obtained through review of 250 patient records in primary care, starting on the day of initiating therapy up to 6 months later, and through expert interviews (2 rounds Delphi method). RESULTS: The model indicates that the expected cost of treating heart failure in 1996 in Belgium was 318,000 Bef over 5 years, for an average number of life years of 3.59. ACE inhibitors are used in 34% of patients but are mostly applied only in higher NYHA classes (more ill patients), although studies recommend to prescribe those drugs earlier in the disease development, since they can avoid morbidity (hospitalisation) and morality. We calculated that starting earlier with ACE inhibitors and doubling their use would increase the total costs to 351,700 Bef for an extra survival time of 0.07 life years. CONCLUSIONS: The study showed that state transition models can be applied in the assessment of the management of heart failure. Changes in the management should be expressed in extra costs per extra life year and compared to interventions in other disease areas.