The healthcare costs of heart failure during the last five years of life: A retrospective cohort study

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Evidence on the economic impact of heart failure (HF) is vital in order to predict the cost-effectiveness of novel interventions. We estimate the health system costs of HF during the last five years of life.

We used linked primary care and mortality data accessed through the Clinical Practice Research Datalink (CPRD) to identify 1,555 adults in England who died with HF in 2012/13. We used CPRD and linked Hospital Episode Statistics to estimate the cost of medications, primary and hospital healthcare. Using GLS regression we estimated the relationship between costs, HF diagnosis, proximity to death and patient characteristics.

In the last 3 months of life, healthcare costs were £8,827 (95% CI £8,357 to £9,296) per patient, more than 90% of which were for inpatient or critical care. In the last 3 months, patients spent on average 17.8 (95% CI 16.8 to 18.8) days in hospital and had 8.8 (95% CI 8.4 to 9.1) primary care consultations. Most (931/1555; 59.9%) patients were in hospital on the day of death. Mean quarterly healthcare costs in quarters after HF diagnosis were higher (£1,439; [95% CI £1,260 to £1,619]) than in quarters preceding diagnosis. Older patients and patients with lower comorbidity scores had lower costs.

Healthcare costs increase sharply at the end of life and are dominated by hospital care. There is potential to save money by implementation and evaluation of interventions that are known to reduce hospitalisations for HF, particularly at the end of life.
Original languageEnglish
Pages (from-to)132-138
Number of pages7
JournalInternational Journal of Cardiology
Early online date15 Sep 2016
Publication statusPublished - 1 Dec 2016

Structured keywords

  • BTC (Bristol Trials Centre)
  • Centre for Surgical Research


  • Health Care Costs
  • HF
  • Terminal Care
  • Hospital Costs


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