Cost of Chronic Heart Failure Among Adult Europeans-A Systematic Literature Review.

Abstract

<h4>Background</h4>Chronic heart failure (CHF) imposes a substantial and growing burden on healthcare systems. While individual studies have evaluated the cost of CHF, variability in reporting standards and regional data gaps limit the comparability of findings.<h4>Objective</h4>This systematic literature review and exploratory meta-analysis aimed to synthesize current evidence on the total annual per-patient cost of CHF in Europe.<h4>Methods</h4>Eligibility Criteria. The review included original studies, published in English, on human adult patients with a diagnosis of CHF from Europe, evaluating its economic burden. Studies were excluded if costs were not expressed in monetary currency, if costs represented fractions of the total cost, or if cost analysis focused either on a specific element of CHF management or intervention or patient subgroup.<h4>Information sources</h4>The review was conducted across PubMed, Embase, Scopus, Web of Science, and the Cochrane Library from January 2008 to March 2025. Risk of Bias. Newcastle-Ottawa scale (NOS) grading was used to assess risk of bias.<h4>Synthesis of results</h4>Costs were adjusted to 2024 euro (€) values using the Harmonised Index of Consumer Prices. An exploratory random-effects meta-analysis was performed to pool mean annual costs, and risk of bias was assessed using validated tools.<h4>Results</h4>Included Studies. In total, 19 studies met inclusion criteria.<h4>Synthesis of results</h4>Across the included studies, the adjusted mean annual total cost of CHF per patient ranged from 3452 € to 23,335 €, reflecting considerable variation in cost estimates across different healthcare systems and study designs. Most studies reported hospitalization as the main cost driver, typically accounting for over half of total direct medical expenditures; 13 studies reported the proportion of total annual cost explained by CHF hospitalization, with a mean of 64.9% ± 18.3%. NOS grading did not exclude any study on the basis of risk of bias alone; from the 19 included studies, only 1 was rated as low risk of bias (NOS = 8), while the majority (16 studies) were evaluated to have moderate risk of bias.<h4>Discussion</h4>Limitations of Evidence. Substantial heterogeneity (I² > 99%) was present across included studies, reflecting differences in healthcare settings, costing methods, and population characteristics. Evidence of potential publication bias was identified, suggesting that lower-cost studies may be underrepresented. Variability in cost components, perspectives (healthcare system versus societal) and geographical representation further limited the precision of the pooled estimate. Future research should prioritize standardized cost reporting and include underrepresented regions to support more accurate economic evaluations and inform health policy decisions.<h4>Registration</h4>The SLR protocol was registered in The International Prospective Register of Systematic Reviews (PROSPERO; CRD420251040430).