Abstract
BACKGROUND: An estimated 10-15% of patients with heart failure (HF) progress to an advanced disease stage. The majority of patients with advanced HF, who are ineligible and/or have no access to expensive, specific therapies such as heart transplant and left ventricular assist devices, are medically managed. The cost of medical treatment for advanced HF is largely unknown. The objective of this scoping review is to summarize the evidence on costs of advanced HF patients who are not treated with advanced therapies, to understand the main settings of this health expenditure, and to map the main cost drivers in this disease stage. METHODS: The PubMed/MEDLINE, Embase, Scopus, and BVS were used as data sources for literature searches evaluating direct costs of patients with advanced HF who were not treated with advanced therapies. Cost methodological categorization, such as micro or macrocosting, payment perspectives, and cost information reported, including the total cost per patient and the main cost drivers, were extracted. Cost methodology heterogeneity was also observed. Despite this, in most studies, cost information was derived from observational cohorts or clinical trials and used either macrocosting or microcosting methods from a public payer perspective. RESULTS: A total of 8157 records were identified, and 16 were included in the review. Criteria for advanced HF varied among studies. Hospitalizations emerged as the main cost driver in the majority of reports. The mean total annual cost per patient was 48,309 international dollars (SD 34,874). Studies from the USA reported higher costs than in other countries. CONCLUSIONS: This review showed that cost methodology to address care of patients with advanced HF is heterogeneous across countries. Despite this heterogeneity, overall, the expenditure could be considered significant, mainly driven by hospitalizations. Further studies with comprehensive cost methodologies are needed to address health expenditure in the advanced HF population. OSF IDENTIFIER: https://doi.org/10.17605/OSF.IO/54GQN .