Resource utilization and costs following hospitalization of patients with chronic heart failure in the US.

BACKGROUND: Despite advances in its management and the identification of preventable risk factors, heart failure (HF) is a growing health problem in the US. The objective of this study was to describe treatment patterns, medical resource utilization and costs following hospitalization for chronic HF for patients stratified by age. METHODS: Patients with at least one hospitalization with chronic HF were identified in a US commercial insurance claims database from 2004-2008. Patients were followed from the 1st day of chronic HF hospitalization (index hospitalization) until disenrollment or end of data availability. Inpatient, outpatient and prescription drug utilization rates were calculated per person per month (PPPM). Costs included payments made by insurers and, where available, patient out-of-pocket payments and sick-leave costs were also calculated. Utilization rates and costs were stratified by patient age. RESULTS: There were 7814 patients included in the study. Index hospitalization was the most resource intensive and expensive ($31,023 age <65, $12,426 age ≥ 65). The rate of outpatient visits was the highest within 3 months following index hospitalization (3.6/PPPM age <65, 4.1/PPPM age ≥ 65). For the older age group, rate of re-hospitalizations was highest (0.06/PPPM) within 3-6 months following index hospitalization, while the younger group had its highest rate (0.08/PPPM) during the first 3 months following index hospitalization. Prescription dispensing rates were similar between age groups; average reimbursement PPPM for cardiovascular drugs did not exceed $92 (age <65) and $221 (age ≥ 65), which represents less than 3% of hospitalization costs for both groups. CONCLUSIONS: Treating chronic HF patients is resource intensive. The greatest burden occurs within 6 months after index hospitalization for both age groups; patients continue to be burdened after hospitalization by high inpatient and outpatient visit rates. Outpatient cardiovascular drug costs account for a small proportion of total healthcare costs.

Development and validation of a disease-targeted quality of life instrument in chronic hepatitis B: the hepatitis B quality of life instrument, version 1.0.

UNLABELLED: Despite the increasing realization that health-related quality of life (HRQOL) is an important outcome in chronic HBV infection, there are no validated, disease-targeted instruments currently available. We sought to develop and validate the first disease-targeted HRQOL instrument in noncirrhotic HBV: the Hepatitis B Quality of Life instrument, version 1.0 (HBQOL v1.0). We established content validity for the HBQOL v1.0 by conducting a systematic literature review, an expert focus group, and cognitive interviews with HBV patients. We administered the resultant questionnaire to 138 HBV patients. We used factor analysis to test hypotheses regarding HRQOL domains and measured construct validity by comparing HBQOL v1.0 scores across several anchors, including viral response to treatment, SF-36 scores, and global health. Finally, we measured test-retest and internal consistency reliability. Content validation revealed that HBV affects multiple aspects of psychological, social, and physical health. The resultant questionnaire summarized this HRQOL impact with 31 items across six subscales: psychological well-being, anticipation anxiety, vitality, disease stigma, vulnerability, and transmissibility. Internal consistency and test-retest reliability were excellent. The HBQOL v1.0 discriminated between viral responders versus nonresponders and correlated highly with SF-36 scores and global health. CONCLUSION: Patients with chronic HBV infection attribute a wide range of negative psychological, social, and physical symptoms to their condition, even in the absence of cirrhosis or cancer. The HBQOL v1.0 is a valid and reliable measure that captures this HRQOL decrement. This instrument may be useful in everyday clinical practice and in future clinical trials.