Cost‑effectiveness analysis of a specialized heart failure patient management system at the regional level

Aim. To conduct a cost-effectiveness analysis of implementing a specialized heart failure (HF) patient management system at the regional level.

Material and methods. The necessary costs for implementing a specialized HF patient management system in average region within the current healthcare system included staff salaries, training costs, and equipment costs for outpatient HF clinics, inpatient HF departments, and HF patient "schools". To assess the potential economic impact of implementing a specialized HF management system in the region, a mathematical HF model was proposed. This model assumed (1) the absence of such a system in the region, (2) current treatment consistent with the PRIORITY-HF study data, and (3) achievement of optimal HF therapy (a combination of an angiotensin receptor-neprilysin inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist, and a sodium-glucose cotransporter-2 inhibitor) in all patients based on the implementation of the specialized heart failure management system. The potential HF population in the region was calculated per 100 000 residents.

Results. Taking into account standards for cardiologist workload and HF prevalence, one outpatient HF center/office for every 400 000 residents should be established. The amount of additional funding required to expand the implementation of specialized HF patient management systems per 100 000 people (based on the costs of equipment, salaries, and training in the first year and salaries in subsequent years) is RUB 1,6 million for the first year, RUB 4,3 million over 3 years, and RUB 13,7 million over the 10-year analysis (i.e., an average of RUB 1,4 million per year). We demonstrated that, by improving the efficiency of patient management, specialized heart failure patient monitoring systems become economically feasible already within the first year of implementation. The overall reduction in budget expenditures, taking into account the costs of implementing specialized HF patient management systems, amounted to RUB 5,5 million, or RUB -3,128 per 1 HF patient subject to monitoring. Moreover, over 10 years of implementation, 827 deaths and 678 hospitalizations due to heart failure will be prevented per 100 000 people, while budget savings (taking into account cost savings on hospitalizations and deaths in patients with HF with a lower probability of disease progression) will amount to RUB 5,5 million in the first year, RUB 13,9 million over 3 years, and RUB 22,9 million over 10 years over the analysis.

Conclusion. The implementation of specialized HF patient management systems may represent an optimal strategy for reducing the burden of disease both in terms of the clinical effectiveness of treatment and economic feasibility.

1. Drapkina OM, Boytsov SA, Omelyanovskiy VV, et al. Socio-economic impact of heart failure in Russia. Russian Journal of Cardiology. 2021;26(6):4490. (In Russ.) doi:10.15829/1560-4071-2021-4490.

2. Shafie AA, Tan YP, Ng CH. Systematic review of economic burden of heart failure. Heart Fail Rev. 2018;23(1):131-45. doi:10.1007/s10741-017-9661-0.

3. Kwok CS, Abramov D, Parwani P, et al. Cost of inpatient heart failure care and 30-day readmissions in the United States. Int J Cardiol. 2021;329:115-22. doi:10.1016/j.ijcard.2020.12.020.

4. Seferović PM, Polovina M, Savarese G, et al. The European heart failure management resources, treatment reimbursement and activities of professional and patient organizations. Eur J Heart Fail. 2025. doi:10.1002/ejhf.3691. Epub ahead of print.

5. Maddox TM, Januzzi JL Jr, Allen LA, et al. 2024 ACC Expert Consensus Decision Pathway for Treatment of Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2024;83(15):1444-88. doi:10.1016/j.jacc.2023.12.024.

6. Villevalde SV, Soloveva AE, Zvartau NE, et al. Principles of organization of medical care for patients with heart failure in the system of cardiovascular risk management: focus on continuity of care and patient routing. Practical materials. Russian Journal of Cardiology. 2021;26(3S):4558. (In Russ.) doi:10.15829/1560-4071-2021-4558.

7. Boytsov SA, Tereshchenko SN, Zhirov IV, Ageev FT. Improving medical care for patients with chronic heart failure. Methodological recommendations. Moscow: Federal State Budgetary Institution "NMIC of Cardiology", 2020. 31 p. (In Russ.)

8. Zvartau NE, Villevalde SV, Konradi AO, et al. Management of health care for patients with heart failure in the Northwestern, North Caucasian, Volga and Southern Federal Districts of the Russian Federation: 6-year changes and future prospects. Russian Journal of Cardiology. 2025;30(3):6276. (In Russ.) doi:10.15829/1560-4071-2025-6276.

9. Reitblat OM, Airapetian AA, Lazareva NV, et al. Creation of registers as one of the mechanisms for improving medical care for patients with chronic heart failure. Problem state. Terapevticheskii Arkhiv (Ter. Arkh.). 2023;95(9):739-45. (In Russ.) doi:10.26442/00403660.2023.09.202370.

10. Fomin IV, Vinogradova NG.Rationale of specialized medical care for patients with chronic heart failure in the Russian Federation. South Russian Journal of Therapeutic Practice. 2020;1(3):44-53. (In Russ.) doi:10.21886/2712-8156-2020-1-3-44-53.

11. Zvartau NE, Solovyova AE, Endubaeva GV, et al. Analysis of the information about the incidence of heart failure, associated mortality and burden on the healthcare system, based on the encoding data in 15 subjects of the Russian Federation. Russian Journal of Cardiology. 2023;28(2S):5339. (In Russ.) doi:10.15829/1560-4071-2023-5339.

12. Shlyakhto EV, Belenkov YuN, Boytsov SA, et al. Interim analysis of a prospective observational multicenter registry study of patients with chronic heart failure in the Russian Federation "PRIORITET-CHF": initial characteristics and treatment of the first included patients. Russian Journal of Cardiology. 2023;28(10):5593. (In Russ.) doi:10.15829/1560-4071-2023-5593.

13. Soloveva AE, Medvedev AE, Lubkovsky AV, et al. Total, ageand sex-specific mortality after discharge of patients with heart failure: the first large-scale cohort real-world study on Russian population. Russian Journal of Cardiology. 2024;29(6):5940. (In Russ.) doi:10.15829/1560-4071-2024-5940.

14. Soloveva AE, Gorbacheva TV, Solovev AE, et al. Cumulative Incidence and Prognostic Value of Readmissions in Patients With Heart Failure: Data From a Large Cohort Study of Real Clinical Practice in St. Petersburg. Kardiologiia. 2024;64(11):96-105. (In Russ.) doi:10.18087/cardio.2024.11.n2781.

15. Tromp J, Ouwerkerk W, van Veldhuisen DJ, et al. A Systematic Review and Network Meta-Analysis of Pharmacological Treatment of Heart Failure With Reduced Ejection Fraction [published correction appears in JACC Heart Fail. 2022;10(4):295-6. doi:10.1016/j.jchf.2022.02.001]. JACC Heart Fail. 2022;10(2):73-84. doi:10.1016/j.jchf.2021.09.004.

16. Lopatin YuM, Nedogoda SV, Arkhipov MV, et al. Pharmacoepidemiological analysis of routine management of heart failure patients in the Russian Federation. Part I. Russian Journal of Cardiology. 2021;26(4):4368. (In Russ.) doi:10.15829/1560-4071-2021-4368.

17. Dolgusheva YuA, Efremova YuE, Gornyakova NB, et al. Chronic heart failure: drug provision, follow-up and application potential of digital technologies. Russian Medical Journal. 2024;8(7):375-85. (In Russ.) doi:10.32364/2587-6821-2024-8-7-3.

18. Irtyuga OB, Nedogoda SV, Sitnikova MYu, et al. Results of the Russian Society of Cardiology survey "Chronic heart failure. Unsolved issues". Russian Journal of Cardiology. 2024;29(6):5944. (In Russ.) doi:10.15829/1560-4071-2024-5944.