Development and Validation of a Markov Microsimulation Model for the Economic Evaluation of Methamphetamine‐Associated Heart Failure in the United States

BACKGROUND: Methamphetamine-associated heart failure (MethHF) is an aggressive HF subtype, and its economic impact on the US health care system is not well defined. METHODS: A Markov microsimulation model from a limited societal perspective was developed to estimate the cost of illness and mortality burden of MethHF over a 20-year time horizon. A hypothetical cohort of 10 000 patients with severe MethHF transitioned through 3 states: mild, severe, and death, with HF hospitalization as a transitional event. Utilities, measured as quality-adjusted life years, and costs, expressed in 2024 US dollars, were based on published literature, and transition probabilities were derived from real-world data. RESULTS: The age of the simulation cohort was 50±6 (mean±SD) years old. Through a median follow-up duration of 5.25 (Quartile 1-Quartile 3: 2.92-9.83) life-years (total 72 562.75 person-years), 2.99 (1.67-5.27) quality-adjusted life years were accrued. The 20-year cost of illness per patient was $627 346±240 282, and the direct cost (from both HF hospitalization and outpatient care) per patient was $421 020±$313 258. Annual cost of illness per patient was $101 652 ($65 039-$171 216), out of which 61.7±29.7% was attributed to direct costs and 38.3±29.7% to premature death. HF hospitalization costs accounted for 87.8±13.3% of direct costs. A total of 8831 (88.3%) patients died from all causes, with age at death at 56±7 years old. The all-cause mortality rate was 1217 deaths per 10 000 person-years. CONCLUSIONS: This Markov microsimulation study underscores the substantial cost and mortality burdens of MethHF. The field of HF care cannot afford to overlook the economic and societal impacts of MethHF, which require urgent interventions.