Value-based health care in heart failure: Quality of life and cost analysis

Abstract Objectives: To measure Quality of Life (QoL) and costs of Heart Failure (HF) outpatients in Brazil as an introduction to the Value-Based Health Care (VBHC) concept. Materials and methods: Cross-sectional study, patients with HF, with ejection fraction <50%, were recruited from three hospitals in Brazil. Two QoL (36-Item Short Form Survey [SF-36] and Minnesota Living with Heart Failure Questionnaire [MLHFQ]) and two anxiety/depression questionnaires were applied. SF-36 scores were stratified by domains. Treatment costs were calculated using the Time-Driven Activity-Based Costing (TDABC) method. Results were stratified by NYHA functional class and sex. Results: From October 2018 to January 2021, 198 patients were recruited, and the median MLHFQ (49.5 [IQR 21.0, 69.0]) and SF-36 scores demonstrated poor QoL, worse at higher NYHA classes. A third of patients had moderate/severe depression and anxiety symptoms, and women had higher anxiety scores. Mean costs of outpatient follow-up were US$ 215 ± 238 for NYHA I patients, US$ 296 ± 399 for NYHA II and US$ 667 ± 1012 for NYHA III/IV. Lab/exam costs represented 30% of the costs in NYHA I, and 74% in NYHA III/IV (US $ 63.26 vs. US$ 491.05). Conclusion: Patients with HF in Brazil have poor QoL and high treatment costs; both worsen as the NYHA classification increases. It seems that HF has a greater impact on the mental health of women. Costs increase mostly related to lab/exams. Accurate and crossed information about QoL and costs is essential to drive care and reimbursement strategies based on value.

Guía metodológica para determinar día cama mediante costeo ABC / Guide methodology for determining the day bed by ABC costing

La atención cerrada de salud es muy compleja por la gran variedad de procedimientos y actividades realizadas por las distintas unidades intervinientes, ya sea directa o indirectamente, en la atención de un problema de salud a un paciente hospitalizado, por lo que la cantidad de recursos utilizados es cada vez mayor y hay una creciente dificultad en determinar los costos involucrados en una atención de una patología en particular, por la variedad de costos indirectos incurridos que provienen de los diversos servicios que directa o indirectamente intervienen y, en definitiva, en su asignación al paciente, por lo que uno de los problemas más importantes a resolver de cualquier sistema de costos, es esta asignación, lo cual lleva a exponer una propuesta metodológica que permite identificar y distribuir los diferentes costos que se incurren por las distintas unidades en una atención de salud a partir de la identificación de los inductores de costo involucrados en un día cama de hospitalización. El principal resultado es que es posible incorporar la valorización del día cama y, por tanto reconocer los costos incurridos, lo que permite contar con un instrumento de medición de costos, que pueda ser homologable y aplicable a distintas unidades.

Care closed health is very complex because of the variety of procedures andactivities conducted by the various units involved, either directly or indirectly,in the care of a health problem to a hospitalized patient, so that the amount ofresources used It is increasing and there is increasing difficulty in determiningthe costs involved in care of a pathology in particular for the variety of incurredindirect costs arising from the various services directly or indirectly involvedand, ultimately, in their allocation patient, so one of the most important toresolve any system cost, is this allocation problems, which leads to expose amethodology for identifying and distributing the different costs incurred bythe different care units health from identifying inducers cost involved in a dayhospital bed. The main result is that it is possible to incorporate the valuationday bed and therefore recognize the costs incurred, which allows for a costmeasurement instrument that can be equivalent and applicable to differentunits.