Real-World Health Care Utilization, Costs of Pulmonary Arterial Hypertension


A recent study evaluated health care utilization and costs of pulmonary arterial hypertension in a real-world setting by comparing periods before and after treatment initiation.

The study was published in the Journal of Managed Care & Specialty Pharmacy (online February 13, 2018; doi:10.18553/jmcp.2018.17391).

Patients with pulmonary arterial hypertension experience a high economic burden due to comorbidities, hospitalizations, and medication costs. While combination therapies have demonstrated the ability to reduce hospitalizations in this disease, the relationship between treatment, health care utilization, and costs remains unclear.

Charles D Burger, MD, FCCP, Mayo Clinic (Jacksonville, FL), and colleagues conducted a retrospective study to provide characterization of health care utilization and costs in real-world settings by comparing periods before and after initiating pulmonary arterial hypertension-specific treatment. A total of 3908 patients were identified who initiated treatment with endothelin receptor antagonists, phosphodiesterase-5 inhibitors, or soluble guanylate cyclase stimulators from 2010 through 2014, as well as those with at least two medical claims with diagnoses for pulmonary arterial hypertension or related conditions and continuous enrollment in medical and pharmacy benefits for the 6 months before and after the index date (the first pulmonary arterial hypertension pharmacy claim).

All-cause and disease-related utilization and costs were measured. Researchers compared patient health care resource utilization and costs in the 6-month pre- and post-treatment periods.

Researchers acknowledged that only 5% of patients began initial combination therapy for pulmonary arterial hypertension and treatment interruption (at least a 30-day gap) of any disease-specific medication was observed in 38% of patients.


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Results of the study showed the proportion of patients in the 6-month post-index period with any inpatient admission decreased compared with the proportion of patients in the 6-month pre-index period (30% vs 42%, respectively; P < .001). Additionally, disease-related inpatient admissions decreased in the 6-month post-index period from 7% to 3% (P < .001).

After treatment initiation, researchers reported that patient non-pharmacy medical costs decreased from $48,200 to $33,962, which was mainly attributable to reduced inpatient costs. Total average medical costs remained comparable after treatment initiation.

Dr Burger and colleagues concluded that while patient pulmonary arterial hypertension-related costs increased after treatment initiation, the increase was offset by reduced inpatient utilization, therefore keeping the total health care costs consistent. “Future cost analyses of patients treated with combination therapy will be required to determine the economic effect of initial combination therapy,” they wrote.—Zachary Bessette