Reduction of heart failure hospitalization-related healthcare costs for transthyretin amyloid cardiomyopathy patients on treatment

Abstract Introduction The efficacy of tafamidis treatment in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) is well known, as supported by findings in the ATTR-ACT trial. However, to our knowledge, no study has investigated the effects of tafamidis at an individual level, using each patient as their control to examine its pre- and post-1-year effects on various hospitalisation parameters. Purpose To investigate the impact of tafamidis on hospital readmission rates, length of stay, and healthcare costs for each patient hospitalised primarily for heart failure (HF) exacerbation. Methods In this retrospective cohort study at a large tertiary care centre, 116 patients with confirmed ATTR-CM initiated on tafamidis therapy were evaluated. Each patient served as their control in the study, and hospitalisation data for one year pre- and post-tafamidis initiation was analysed. Generalised linear models were employed to compare primary HF-related hospital admission length and admission frequencies between pre- and post-treatment periods. Subgroup analyses were conducted regarding baseline New York Heart Association (NYHA) class and left ventricular ejection fraction (LVEF). Results The baseline cohort demographics are shown in Table 1. Treatment with tafamidis was associated with a significant reduction in the total mean number of hospital days within 1-year, from 2. 66±5. 51 to 1. 55±5. 10 days with an absolute decrease of 1. 11 days per patient (p-value 0. 001) and a 43% reduction in 1-year HF hospitalisations. Stratified analyses revealed differential treatment response, with more significant relative reductions in hospital length of stay observed in patients with NYHA class I-II (99. 1% reduction; p0. 001) and preserved LVEF (58. 9% reduction; p0. 001) compared to those with NYHA class III-IV (22. 4% reduction; p=0. 271) and reduced LVEF (33. 0% reduction; p=0. 058). Based on an estimated hospitalisation cost of 2960 per day for HF admission at our institution, the observed reduction in hospital length of stay corresponded to an approximate cost savings of 3285 per patient during the first year of treatment. Conclusion Treatment with tafamidis significantly reduced length of hospital stay, which amounted to 1-year savings of approximately 3285 per patient, with the NYHA I/II and LVEF 50% groups benefitting the most. It should be noted that the true cost-effectiveness of tafamidis is likely underestimated as patients with reduced 1-year readmissions are also more likely to have reduced hospitalisations later due to adequate disease control. In addition, a 43% reduction by tafamidis in HF readmissions supplement additional healthcare savings. Taken together, our study shows that timely treatment of patients with ATTR-CM can substantially improve healthcare spending and burden. Table 1: Demographics