New Publication Chair Health Economics, Policy and Management

Title: Hospitalizations and inpatient resource consumption of patients suffering from chronic disease – Past trend and forecast for Switzerland

Background: Chronic diseases currently impose a substantial health and financial burden on the Swiss health system. With an ageing population affecting both the demand (patients) and supply (primary care physicians) of healthcare services, this burden is bound to increase. Identifying the magnitude of this burden and factors that can prevent the continuous growth of potentially avoidable hospitalisations is essential.

Methods: We identified PAHs in retrospective routine hospital data and derived numbers of occupied hospital beds, based on cases’ length of stay, and inpatient healthcare expenditures, based on diagnosis-related group payments. We also utilized population forecasts for Switzerland to extrapolate PAH-volume in the base scenario. Additionally, we predicted via linear regression how reduced ageing-induced PCP-availability might affect PAHs. Finally, we explored the potential impact of countermeasures, optimal Guideline-Directed Medical Therapy (GDMT)-implementation, for CHF and COPD.

 Key results: 

• +34% increase in annual PAH cases from 30.1 → 40.2 thousand (2012 → 2019),
• PAHs are projected to grow +37% further to 54.9 thousand per year by 2032 (vs 2019),
• ≈1.8 thousand hospital beds may be continuously occupied by PAHs by 2032, with costs reaching CHF 565–604 million annually,
• Declining PCP availability may add another +11%, resulting in 60.7 thousand PAH cases per year in 2032 — a cumulative +51% rise since 2019,
• Optimal Guideline-Directed Medical Therapy (GDMT) could significantly mitigate this trajectory:

       1. CHF-related PAHs: −31% (95% CI: 22.2–37.6%),
       1. COPD-related PAHs: −14% (95% CI: 2.2–26.0%) by 2032.

Conclusions: Our study assesses cumulative PAH-trends and is the first to forecast future burden in Switzerland. A strong rise in PAHs and associated inpatient resources was observed for the last decade, with accelerating growth expected throughout the next. A depleting healthcare workforce may exacerbate burden. Optimal GDMT-implementation could potentially curb increases in PAHs. However, methods to reach optimal implementation require further research and policy efforts.