HF care puts a dent on SG’s healthcare system

A study evaluating the annual healthcare burden of heart failure with reduced ejection fraction (HFrEF; EF <40 percent) in Singapore shows that hospital-based HF care has a significant financial impact on Singapore’s healthcare system.

“[There was] a complex relationship … between hospital admission [HA] rates and associated costs, indicating shifts in treatment efficacy and patient outcomes,” said the researchers.

The study leveraged data from the SingCLOUD* database. A total of 1,631 HFrEF patients (70.5 percent men, 53.7 percent aged 50–69 years) who met the inclusion criteria (ie, those who had an HF-related HA in 2011) were prospectively followed for 9 years. Fifty-eight percent of patients (n=941) died across the 9-year follow-up period. [Value Health Reg Issues 2025;doi:10.1016/j.vhri.2024.101037]

Two years after the index HA, about a quarter of patients alive (n=1,361) had an HF-related HA. Since then, a consistent drop has been observed that by year 9, only 3.2 percent of patients alive (n=717) had an HF-related HA.

The mean all-cause per-admission (PA) cost gradually increased from year 1 onwards with minor ebbs and flows, peaking at $2,467 by year 9. Conversely, mean HF-related PA cost varied significantly, reaching its highest by year 2 ($6,566) and plummeting by year 9 ($1,037).

Despite the substantially higher HF-related vs all-cause PA costs in the early years, the latter at year 2 surpassed the former by a significant margin by year 9, the researchers noted.

The mean annual all-cause per-patient (PP) cost remained stable, ranging between S$16,000 and S$18,800. Conversely, mean HF-related PP cost varied significantly, drastically jumping from $5,182 at year 1 to $13,313 by year 2 then dropping profoundly to $1,320 by year 9.

Increased costs at end of life

Both all-cause and HF-related HA costs increased in the final year of life by 24 percent and 54 percent from the previous year, respectively. Annual PP costs tied to mean all-cause and HF-related HAs steadily increased as patients approached end of life: the mean all-cause PP cost by the final year of life was $29,479 (a third due to HF-related HAs).

“[T]here was a consistent upward trend in outpatient resource utilization, marked by an increase in … outpatient visits, cost per outpatient visit, and annual PP cost for outpatient visits [as patients neared death],” the investigators explained, adding that these data underscore the financial strains encountered during this phase.

However, the increase in per-hospital day cost was comparatively modest (15 percent higher than the year prior), suggesting that the overall increase was more likely due to the increased HA frequency and longer hospital stays rather than the use of pricier treatment alternatives.

Groundwork for economic assessment

The results provide a robust foundation for future economic evaluations, the investigators said. “This exploration into the cost of HF care, with a specific focus on Singapore, aims to fill the existing knowledge gap, enabling a more judicious and evidence-based approach to managing the economic burden of this prevalent condition.”

The detailed cost analysis offers valuable insights into the financial burden of managing HFrEF over a long period. It may also aid in evaluating more cost-effective management strategies (eg, new therapeutic modalities, care models) that can alleviate the economic pressures on the healthcare system while improving patient outcomes.

“These cost data are crucial for informing healthcare planning and resource allocation, especially in the context of rising healthcare costs and an ageing population,” they added. “By understanding the cost trajectories and identifying key cost drivers, healthcare policymakers can make more informed decisions about allocating resources efficiently and prioritizing interventions that offer the greatest value for money.”