Relationship Between Anemia and Health Care Costs in Heart Failure

BackgroundAnemia is associated with higher morbidity and mortality in patients with heart failure (HF), but its implications for heath care costs are not well described.Methods and ResultsWe analyzed data on 1056 patients with symptomatic HF seen at Duke University between 2002 and 2006. Health care costs were obtained from the hospital cost accounting data system. Adjustments for censoring and covariate imbalance were performed using inverse probability weighted estimators and propensity scores. The prevalence of anemia was 32%. Unadjusted mortality at 3 years was 50.3% in anemic versus 26.5% in non-anemic patients. The adjusted costs per year alive were $22,926 for patients with anemia and $17,189 for those without (P = .04). For those with ejection fraction ≤40% adjusted costs per year alive were $32,914 for anemic versus $18,423 for non-anemic patients (P = .01).ConclusionsAnemia in HF patients was independently associated with greater total costs after accounting for differences in survival, but appeared to be confined primarily to patients with low ejection fraction. These results provide a framework for understanding the economic implications of therapies for anemia in heart failure, and suggest that targeting patients with impaired systolic function has the potential to most favorably affect costs.