급성심부전 환자의 의료이용행태와 의료비 추이: 2013-2016 건강보험 입원환자청구자료 분석

Abstract

Objectives: Objective of this study is to utilize Health Insurance Review and Assessment Service- National Inpatient Sample (HIRA-NIS) claims data of four years to analyze trends of costs and treatment pattern of acute heart failure (AHF) in Korea. Methods: AHF patients are defined as patients with KCD-6 code for heart failure as main or sub sickness and have been hospitalized or have used emergency care service. Using the HIRA-NIS data, prevalence and direct medical costs of AHF in year 2013, 2014, 2015, and 2016 were calculated. In addition, costs were divided into inpatient care costs, outpatient care costs and medication costs for each year. Also, patients were divided into subgroups “primary/secondary/tertiary healthcare user,” “intensive care unit (ICU) user/non-user,” “inotrope user/non-user,” and “emergency care user/non-user” to compare proportion and costs for each year. Results: Prevalence of AHF has increased from 0.11% to 0.13% and it was much higher in patients aged 65 or older (0.73−0.76% vs. 0.028−0.032%). Average yearly costs per patient increased from 3639690 KRW to 4311138 KRW. While inpatient costs have significantly increased, outpatient and medication costs did not. More patients are visiting secondary and tertiary hospitals and costs of every healthcare institution have increased. Costs for ICU patients and inotrope users have increased from 7604487 KRW to 9349315 KRW over two years and from 8441870 KRW to 10603535 KRW over three years, respectively. Conclusion: Costs of AHF treatment is generally increasing with patients visiting tertiary hospitals and costs of inpatient care. Especially, costs for patients who visit intensive care unit and who use inotropic agent have significantly increased. Further research should be conducted to review the factors affecting the costs increase for ICU visitors and inotropic users.