Historical Drug Costs Among Elderly Patients Hospitalized with Heart Failure in Canada, 2013-2014 to 2018-2019.

BACKGROUND: Heart failure (HF) management guidelines continue to evolve with emerging evidence from landmark trials defining new standards for guideline-directed medical therapy (GDMT). However, data on HF drug costs in Canada remain limited. This study examined long-term historical costs of drugs associated with HF management among elderly patients hospitalized with HF between 2013-2014 and 2018-2019. METHODS: Prescription claims from the National Prescription Drug Utilization Information System were linked for patients aged > 65 years with a HF hospitalization between April 1, 2013 and March 31, 2019 in Canada, except Quebec, Nova Scotia, and the Territories. HF management drugs included GDMT and diuretics; costs were inflated to 2025 Canadian dollars. Annual total and per-patient drug costs were calculated. RESULTS: The total drug cost for managing HF in 163,973 elderly hospitalized patients over the 5-year period was CAD$252.2 million. Although average annual per-patient costs remained relatively stable ($567 in 2013/-2014 to $593 in 2018-2019), total annual costs rose from $31.5 million to $50.8 million, driven largely by an increase in the number of patients hospitalized with HF. GDMT accounted for the majority of drug costs, and its level of use increased from 72.2% to 76.0%. In 2018-2019, costs were higher in male patients ($632) than female patients ($558), were highest among patients aged 65-74 years ($680), and were lowest among those aged ≥ 90 years ($493). CONCLUSIONS: The cost of drugs to manage HF is substantial and is increasing over time, primarily as a result of the increasing number of patients being hospitalized with HF. Modest shifts occurred toward greater use of GDMT, with variations across province, sex, and age groups.