Cost analysis of transthyretin amyloid cardiomyopathy in heart failure patients with preserved ejection fraction in Spain

BACKGROUND: Transthyretin amyloid cardiomyopathy (ATTR-CA) is a progressive, fatal disease that often presents as heart failure with preserved ejection fraction (HFpEF). To date, scarce evidence about the economic burden of ATTR-CA has been published. This study compared the economic impact of HFpEF in patients with and without ATTR-CA in Spain. METHODS: The PRACTICA study was a cross-sectional, multicenter, nationwide study in twenty sites in Spain. A total of 387 consecutive ambulatory or hospitalized patients aged ≥ 50 years with HFpEF and LVH ≥ 12 mm were included and screened for ATTR-CA. Healthcare resource utilization (HRU), except specific pharmacologic treatments, non-HRU and its associated average cost per-patient per-year were assessed in year 2021 for ATTR-CA and non-ATTR-CA patients. RESULTS: Patients were classified as: ATTR-CA (n = 65), non-ATTR-CA (n = 306) and inconclusive (n = 16). Mean total cost per-patient per-year was higher in ATTR-CA patients: €3,407 (Min-Max: €1,067-€6,473) in ATTR-CA, €3,203 (€1,168-€5,646) in non-ATTR-CA and €2,920 (€1,165-€5,080) in inconclusive patients (p < 0.001, Kruskal-Wallis). Determinants of differential cost favoring ATTR-CA were hospitalizations, genetic testing, implantable cardiac defibrillator, and scintigraphy. No statistical differences were observed between patients with and without ATTR-CA in non-healthcare resources paid by patients themselves, although inconclusive patients showed significantly higher home adaptation (shower, bed rail) and crutch utilization (p = 0.031, Kruskal-Wallis). CONCLUSIONS: This is the first multicenter nationwide study assessing the economic impact on Spanish society of ATTR-CA patients with HFpEF and LVH ≥ 12 mm. The cost was substantial, with negative implications particularly for the Spanish National Health System.