ISSN : 2146-3123
E-ISSN : 2146-3131

Cost-of-disease of Heart Failure in Turkey: A Delphi Panel-based Analysis of Direct and Indirect Costs
Yüksel Çavuşoğlu1, Hakan Altay2, Dursun Aras3, Ahmet Çelik4, Fatih Sinan Ertaş5, Barış Kılıçaslan6, Sanem Nalbantgil7, Ahmet Temizhan3, Dilek Ural8, Özlem Yıldırımtürk9, Mehmet Birhan Yılmaz10
1Department of Cardiology, Faculty of Medicine Eskisehir Osmangazi University, Eskişehir, Turkey
2Department of Cardiology, Faculty of Medicine Başkent University, İstanbul, Turkey
3Clinic of Cardiology University of Health Sciences Turkey, Ankara City Hospital, Ankara, Turkey
4Department of Cardiology, Faculty of Medicine Mersin University, Mersin, Turkey
5Department of Cardiology, Faculty of Medicine Ankara University, Ankara, Turkey
6Clinic of Cardiology, University of Health Sciences Turkey İzmir Tepecik Training and Research Hospital, İzmir, Turkey
7Department of Cardiology, Faculty of Medicine Ege University, İzmir, Turkey
8Department of Cardiology, Faculty of Medicine Koç University, İstanbul, Turkey
9Clinic of Cardiology, University of Health Sciences Turkey Siyami Ersek Training and Research Hospital, İstanbul, Turkey
10Department of Cardiology, Faculty of Medicine Dokuz Eylül University, İzmir, Turkey
DOI : 10.4274/balkanmedj.galenos.2022.2022-3-97
Pages : 282-289

Background: Heart failure (HF) is considered a significant public health issue with a substantial and growing epidemiologic and economic burden in relation to longer life expectancy and aging global population
Aims: To determine cost-of-disease of heart failure (HF) in Turkey from the payer perspective.
Study Design: Cross-sectional cost of disease study.
Methods: In this cost-of-disease study, annual direct and indirect costs of management of HF were determined based on epidemiological, clinical and lost productivity inputs provided by a Delphi panel consisted of 11 experts in HF with respect to ejection fraction (EF) status (HF patients with reduced EF (HFrEF), mid-range EF (HFmrEF) and preserved EF (HFpEF)) and New York Heart Association (NYHA) classification. Direct medical costs included cost items on outpatient management, inpatient management, medications, and non-pharmaceutical treatments. Indirect cost was calculated based on the lost productivity due to absenteeism and presenteeism.
Results: 51.4%, 19.5%, and 29.1% of the patients were estimated to be HFrEF, HFmrEF, and HFpEF patients, respectively. The total annual direct medical cost per patient was $887 and non-pharmaceutical treatments ($373, 42.1%) were the major direct cost driver. Since an estimated nationwide number of HF patients is 1,128,000 in 2021, the total annual national economic burden of HF is estimated to be $1 billion in 2021. The direct medical cost was higher in patients with HFrEF than in those with HFmrEF or HFpEF ($1,147 vs. $555 and $649, respectively). Average indirect cost per patient was calculated to be $3,386 and was similar across HFrEF, HFmrEF and HFpEF groups, but increased with advanced NYHA stage.
Conclusion: Our findings confirm the substantial economic burden of HF in terms of both direct and indirect costs and indicate that the non-pharmaceutical cost is the major direct medical cost driver in HF management, regardless of the EF status of HF patients.

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