Seven-fold variation in average costs of treating patients at multidisciplinary heart failure clinics across Ontario: ICES study

The cost of treating patients at multidisplinary heart failure clinics varies significantly across the province, according to new research by the Institute for Clinical Evaluative Sciences (ICES) and the Toronto Health Economics and Technology Assessment (THETA) collaborative.

The findings, published today in Medical Care, found in heart failure patients discharged from hospital after an acute episode and seen in a specialized heart failure clinic in Ontario within a year of discharge, there is a very wide range in one-year costs between patients ($69 -$343,743) as well as a seven-fold variation in mean costs between clinics.

“We were interested in what patient factors or heart failure clinic quality indicators predicted costs. We found that variation in patient-level costs was predominantly due to unmeasured patient-level differences. However, almost half of the variation between clinics was due to differences in clinic factors,” said Dr. Harindra Wijeysundera, lead author and adjunct scientist at ICES.

The retrospective cohort study using administrative data identified 1,216 heart failure patients who had an acute care hospitalization in 2006 and were treated at a heart failure clinic within one year after hospital discharge and found:

• The mean one-year cost was $27,809 per patient (range, $69 to $343,743)
• There was a seven-fold variation in mean patient costs by clinic, from $14,670 to $96,524.
• Delays in being seen at a heart failure clinic were associated with higher costs, reinforcing the importance of early referral.
• Clinics that had more than three physicians had 26 per cent lower annual mean costs per patient   

“Our study shows the wide spectrum of heart failure clinic structures and programs translates into inefficient care. Greater guidance as to the type of patient seen at a heart failure clinic, the timeliness of the initial visit, and the most appropriate structure of the heart failure clinics may potentially result in more cost-effective care,” adds Wijeysundera, who is also a cardiologist at the Schulich Heart Centre in Sunnybrook Health Sciences Centre.

The study “The effect of multidisciplinary heart failure clinic characteristics on 1-Year postdischarge healthcare costs – A population-based study,” was published in Medical Care.

Authors: Harindra C. Wijeysundera, Peter C. Austin, Xuesong Wang, Maria C. Bennell, Lusine Abrahamyan, Dennis T. Ko, Jack V. Tu, and Murray Krahn.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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