Cause-Specific Healthcare Costs Following Hospitalization for Heart Failure and Cost Offset with SGLT2 Inhibitor Therapy

Background Little is known regarding differences in cause-specific costs between HF with EF≤40% versus >40%, and potential cost implications of SGLT2i therapy. Objectives To compare cause-specific healthcare costs following hospitalization for heart failure (HF) with ejection fraction (EF) ≤40% versus >40%, and estimate the cost offset with implementation of SGLT2 inhibitor (SGLT2i) therapy. Methods We examined Medicare beneficiaries hospitalized for HF in the Get With The Guidelines-Heart Failure registry from 2016-2020. Mean per-patient total (excluding drug costs) and cause-specific costs from discharge through 1-year follow-up were calculated and compared between EF≤40% vs >40%. We then estimated risk reductions on total all-cause and HF hospitalizations in a trial-level meta-analysis of 5 pivotal trials of SGLT2i in HF. Finally, we applied these relative treatment effects to Medicare beneficiaries eligible for SGLT2i to estimate the projected cost offset with implementation of SGLT2i, excluding drug costs. Results Among 146,003 patients, 50,598 (34.7%) had EF≤40% and 95,405 (65.3%) had EF>40%. Mean total cost through 1-year was $40,557. Total costs were similar between EF groups overall, but higher for EF≤40% among patients surviving the 1-year follow-up period. Patients with EF>40% had higher costs due to non-HF and non-cardiovascular hospitalizations, and skilled nursing facilities (all p<0.001). Trial-level meta-analysis of the 5 SGLT2i clinical trials estimated 11% (rate ratio 0.89; 95% CI 0.84-0.93; P<0.001) and 29% (rate ratio 0.71; 95% 0.66-0.76; P<0.001) relative reductions in rates of total all-cause and HF hospitalizations, respectively, regardless of EF. Reductions in all-cause and HF hospitalizations were projected to reduce annual costs of readmission by $2,451-2,668 per patient with EF≤40%, and $1,439-2,410 per patient with EF>40%. Conclusions In this large cohort of older US adults hospitalized for HF, cause-specific costs of care differ among patients with EF≤40% versus EF>40%. SGLT2i significantly reduces the rate of HF and all-cause hospitalizations irrespective of EF in clinical trials, and implementation of SGLT2i in clinical practice is projected to reduce costs by $1,439-2,668 per patient over the 1-year post-discharge, excluding drug costs.