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Original Articles

Cost-Consequences of Ultrafiltration for Acute Heart Failure

A Decision Model Analysis

Steven M. Bradley, MD, MPH; Wayne C. Levy, MD and David L. Veenstra, PharmD, PhD

From Health Services Research & Development (S.M.B.), VA Puget Sound Health Care System, Seattle, Wash; and the Division of Cardiology, Department of Medicine (S.M.B., W.C.L.) and the Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy (D.L.V.), University of Washington, Seattle, Wash.

Correspondence to Steven M. Bradley, MD, MPH, VA Puget Sound Health Care System, Health Services Research & Development, Department of Veterans Affairs, 1100 Olive Way, Suite 1400, Seattle, WA 98101. E-mail Steve.Bradley{at}va.gov

Received January 23, 2009; accepted September 1, 2009.

Background— Ultrafiltration for heart failure may reduce costs associated with acute heart failure by decreasing rehospitalization rates compared to intravenous diuretics.

Methods and Results— We developed a decision-analytic model to explore the clinical outcomes and associated costs of ultrafiltration compared to intravenous diuretics for index and subsequent acute heart failure hospitalizations to 90 days from index hospitalization. We evaluated the model from societal, Medicare, and hospital payer perspectives. Base-case probabilities and costs were derived from the Ultrafiltration versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Congestive Heart Failure clinical trial, Medicare reimbursement schedules, and published data. From a societal perspective, treatment with ultrafiltration had an 86% probability of being more expensive than intravenous diuretics in probabilistic sensitivity analysis, with a base-case estimate of $13 469 per patient treated with ultrafiltration compared to $11 610 per patient treated with intravenous diuretics. Cost estimates were most influenced by length of index hospitalization, daily cost of rehospitalization, number of days rehospitalized, and number and cost of ultrafiltration filters. From a Medicare payer perspective, ultrafiltration had a >99% probability of being cost saving. From a hospital perspective, there was a 97% probability ultrafiltration was more expensive. Our model suggested similar 90-day mortality rates between treatment arms.

Conclusion— Despite a reduction in rehospitalization rates, it is unlikely ultrafiltration results in cost savings from a societal perspective. The discordance in cost between societal, Medicare, and hospital perspectives underscores the importance of payer perspective in formulating strategies and reimbursement structures to reduce heart failure hospitalizations.

Key Words: heart failure • ultrafiltration • diuretics • costs and cost analysis

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

The online-only Data Supplement is available at http://circoutcomes.ahajournals.org/cgi/content/full/CIRCOUTCOMES.109.853556/DC1.