J Manag Care Spec Pharm. 2026 Jun;32(6):670-678. doi: 10.18553/jmcp.2026.32.6.670.
ABSTRACT
BACKGROUND: Heart failure (HF) is a leading cause of morbidity, mortality, and health care utilization in the United States. Its burden is expected to increase with population aging and the growing prevalence of diabetes, yet comprehensive estimates of health care costs and health-related quality of life (HRQoL) stratified by age and diabetes status-2 key drivers of HF risk and resource use-remain limited.
OBJECTIVE: To quantify the economic burden and HRQoL impact of HF in the United States, stratified by age and diabetes status.
METHODS: Using a micro-level, bottom-up prevalence-based approach from a payer perspective, we analyzed health care costs from the Optum Research Database. HF prevalence and HRQoL via EuroQol 5-Dimensions and Healthy Days instruments were estimated using the National Health and Nutrition Examination Survey.
RESULTS: The average annual direct health care cost per patient with HF was approximately $31,464 at baseline, rising to $45,893 in the first year after diagnosis before stabilizing around $37,500 annually. Inpatient and emergency care accounted for the largest cost share. Extrapolating at the national level, expenditures exceeded $227 billion at baseline and peaked at $332 billion in the year following an HF hospitalization. Individuals without diabetes had the highest quality-adjusted life-years (QALYs) and lowest costs, whereas patients with type 1 diabetes had the lowest QALYs and highest costs. Patients with type 2 diabetes represented the largest subgroup with intermediate QALYs but substantial costs.
CONCLUSIONS: HF imposes a significant, sustained economic and quality-of-life burden, highlighting the need for targeted management strategies, especially for older adults and those with diabetes.
PMID:42166305 | DOI:10.18553/jmcp.2026.32.6.670