Cost Burden and Drivers of Cost Among Commercially Insured Population with Coronary Artery Disease (CAD) or Congestive Heart Failure (CHF): 2008 through 2012

Objective: 

To investigate health care utilization and cost trends and driving factors for patients with Coronary Artery Disease (CAD) or Congestive Heart Failure (CHF) in a large commercially insured population.

Methods:

In each quarter from 2008 to 2012, the studied population included nearly two million diverse adult commercially insured members. In a given quarter, members with CAD/CHF were identified using the prior one year’s claims based on disease identification algorithm created by the Care Continuum Alliance Outcomes Guidelines for industry population health management programs. Quarterly costs were inflation adjusted.

Results:

From 2008Q1 to 2012Q4, CAD prevalence decreased from 0.85% to 0.68%, while CHF prevalence remained stable at 0.3%. CAD members’ contribution to total medical cost decreased from 7.6% to 6.0%, while CHF members’ contribution was stable at 5%. For CAD/CHF members, inpatient care constituted 70% of their medical cost, inpatient discharge rate decreased by 20%, and average length of inpatient stays decreased by 22% over time. Cardiac surgeries contributed 50% of inpatient cost for CAD members and 23% for CHF members. The volume of cardiac surgeries decreased by 40%, however cost of percutaneous coronary intervention increased by 20%. Cost of anti-diabetic drugs, the most commonly used non-cardiac drugs, increased by 42% for CAD members and 28% for CHF members.

Conclusions:

The decreasing burden CAD/CHF members imposed on total medical cost over time was largely caused by decline in both inpatient hospitalizations and the volume of cardiac surgeries. The primary co-morbidity that had a significant influence on CAD/CHF members is diabetes.