Historical Drug Costs among Elderly Patients Hospitalized with Heart Failure in Canada, 2013/14–2018/19

Background: Heart failure (HF) management guidelines continue to evolve with emerging evidence from landmark trials defining new standards for guideline-directed medical therapy (GDMT).However, data on HF drug costs in Canada remain limited.This study examined longterm historical costs of drugs associated with HF management among elderly patients hospitalized with HF between 2013/14 and 2018/19. Methods: Prescription claims from the National Prescription Drug Utilization InformationSystem were linked for patients aged >65 years with a HF hospitalization between April 1, 2013 -March 31, 2019 in Canada, except Quebec, Nova Scotia, and territories.HF management drugs included GDMT and diuretics; costs were inflated to 2025 Canadian dollars.Annual total and per-patient drug costs were calculated. Results:The total drug cost for managing HF in 163,973 elderly hospitalized patients over the five-year period was $252.2 million.While average annual per-patient costs remained relatively stable ($567 in 2013/14 to $593 in 2018/19), total annual costs rose from $31.5 million to $50.8 million, largely driven by an increase in the number of patients hospitalized with HF.GDMT accounted for the majority of drug costs, and increased from 72.2% to 76.0%.In 2018/19, costs were higher in males ($632) than females ($558), and highest among patients aged 65-74 years ($680) and lowest among those 90+ ($493) years.J o u r n a l P r e -p r o o f 4 Conclusions: The costs of drugs to manage HF is substantial and is increasing over time, primarily as a result of increasing number of patients hospitalized with HF.There were modest shifts toward greater use of GDMT, with variations across province, sex, and age groups.