Excess Costs Associated with Patients with Pulmonary Arterial Hypertension in a US Privately Insured Population

Kirson, Noam Y.; Birnbaum, Howard G.; Ivanova, Jasmina I.; Waldman, Tracy; Joish, Vijay N.; Williamson, Todd

doi:10.2165/11592430-000000000-00000

Cited by 45 publications

(65 citation statements)

References 22 publications

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“…Although this study is from a developing country, the association between lower SES and poorer health outcomes in patients with chronic disease is well documented in developed countries (7)(8)(9). Furthermore, economic burden (18), inequitable distribution of public services (34), adherence to treatment, and other factors may also exist in developed countries. The magnitude of the differentials in health and mortality can vary across countries with distinct economic, political, and social policies (51).…”

Section: Discussionmentioning

confidence: 99%

“…Wilkens and colleagues reported that each patient with PAH in Germany spends €47,400 per year on average, primarily due to drug costs (16,17). In the United States, the economic burden of privately ensured patients with PAH is substantial (18). In addition, low The funding sources provided financial support for the study but played no role in the study design or conduct, data collection and analysis, or the decision to submit the manuscript for publication.…”

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confidence: 99%

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Lower Socioeconomic Status Is Associated with Worse Outcomes in Pulmonary Arterial Hypertension

Yang²,

Peng³

et al. 2013

Am J Respir Crit Care Med

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Rationale: Lower socioeconomic status (SES) confers a heightened risk of common cardiovascular and pulmonary diseases and increased mortality. The association of SES with outcomes in patients with pulmonary arterial hypertension (PAH) is less clear. Objectives: To determine the association between SES and outcomes in patients with PAH. Methods: We performed a prospective cohort study at a national referral center for patients with PAH in China. Two hundred sixty-two consecutive incident patients aged 18 to 65 years with a diagnosis of idiopathic PAH were recruited between January 2007 and June 2011 and followed up until November 2011. The primary endpoint was all-cause mortality. An SES score for each patient was derived from their educational level, annual household income, occupation, and medical reimbursement rate. Measurements and Main Results: Patients with a lower SES had higher unadjusted mortality rates, with 3-year survival estimates of 50.1, 70.8, and 86.0% in increasing tertiles of SES (P for trend , 0.001). After adjustment for clinical features, hemodynamics, and type of PAH treatment, the hazard ratios for death were 2.98 (95% confidence interval, 1.51-5.89) in the lowest tertile of SES and 1.80 (95% confidence interval, 0.89-3.63) in the middle tertile of SES compared with the upper tertile (P for trend ¼ 0.006).Conclusions: A lower SES is strongly associated with a higher risk of death in idiopathic PAH. This association was independent of clinical characteristics, hemodynamics, and treatment. Addressing the health disparities associated with a lower SES may improve the outcomes of patients with PAH.Keywords: pulmonary arterial hypertension; socioeconomic status; survival Pulmonary arterial hypertension (PAH) is a disease of the small muscular pulmonary arteries characterized by a progressive rise in pulmonary artery pressure and pulmonary vascular resistance (PVR), ultimately resulting in right heart failure and death (1-3). Treatment for PAH includes anticoagulants, diuretics, prostanoids, phosphodiesterase 5 inhibitors, and endothelin receptor antagonists (ERAs) (3-5). Although survival may have improved, patients with PAH still have a greatly increased risk of death, even with approved treatments. Socioeconomic status (SES) is defined by education, income, occupation, and social status and refers to an individual's social standing relative to other members of a society (6). A low SES is associated with increased risks of cardiovascular and pulmonary disease and mortality (7-11). However, the association of SES with outcomes in PAH has not been well studied.Socioeconomic-related inequalities in health and healthcare have increased over recent decades in . Approximately 75 to 80% of individuals with low annual household incomes do not carry medical insurance (15), potentially greatly increasing the economic burden of PAH on patients. Wilkens and colleagues reported that each patient with PAH in Germany spends €47,400 per year on average, primarily due to drug costs (16,17). In the United States...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Lower Socioeconomic Status Is Associated with Worse Outcomes in Pulmonary Arterial Hypertension

Yang²,

Peng³

et al. 2013

Am J Respir Crit Care Med

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“…4 Patients with pulmonary arterial hypertension (PAH) have significantly higher health care costs and comorbidity than patients without PAH. 5 Thus an argument can be made for improved recognition and management of PH in diabetic individuals.…”

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confidence: 99%

Impact of Diabetes in Patients with Pulmonary Hypertension

Abernethy¹,

Stackhouse

Hart

et al. 2015

Pulm. circ.

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Diabetes complicates management in a number of disease states and adversely impacts survival; how diabetes affects patients with pulmonary hypertension (PH) has not been well characterized. With insulin resistance having recently been demonstrated in PH, we sought to examine the impact of diabetes in these patients. Demographic characteristics, echo data, and invasive hemodynamic data were prospectively collected for 261 patients with PH referred for initial hemodynamic assessment. Diabetes was defined as documented insulin resistance or treatment with antidiabetic medications. Fifty-five patients (21%) had diabetes, and compared with nondiabetic patients, they were older (mean years ± SD, 61 ± 13 vs. 56 ± 16; [Formula: see text]), more likely to be black (29% vs. 14%; [Formula: see text]) and hypertensive (71% vs. 30%; [Formula: see text]), and had higher mean (±SD) serum creatinine levels (1.1 ± 0.5 vs. 1.0 ± 0.4; [Formula: see text]). Diabetic patients had similar World Health Organization functional class at presentation but were more likely to have pulmonary venous etiology of PH (24% vs. 10%; [Formula: see text]). Echo findings, including biventricular function, tricuspid regurgitation, and pressure estimates were similar. Invasive pulmonary pressures and cardiac output were similar, but right atrial pressure was appreciably higher (14 ± 8 mmHg vs. 10 ± 5 mmHg; [Formula: see text]). Despite similar management, survival was markedly worse and remained so after statistical adjustment. In summary, diabetic patients referred for assessment of PH were more likely to have pulmonary venous disease than nondiabetic patients with PH, with hemodynamics suggesting greater right-sided diastolic dysfunction. The markedly worse survival in these patients merits further study.

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“…This likely contributed to an accurate diagnosis and management of PAH at the expense of increasing healthcare costs [21]. A study by Kirson et al that analyzed a private insurance database from 2002-2007 demonstrated as compared to the general population patients with PAH had substantially higher costs and comorbidity resulting in 40% of excess costs associated with management and treatment of PAH patients [22]. On the contrary, management of PH WHO Group II & III is focused on treatment of the underlying disease.…”

Section: Health Utilization Costsmentioning

confidence: 99%

Nationwide Trends in Inpatient Admissions of Pulmonary Hypertension in the United States from 2000 to 2013

Sikachi

Sahni

Mehta

et al. 2017

Advances in Respiratory Medicine

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Introduction: Pulmonary Hypertension (PH) is a disorder of the pulmonary vasculature with high mortality and bears a large economic burden on the healthcare system. We conducted a review of the largest inpatient database in the United States and analyzed the trends in hospitalizations due to PH from the turn of the century (2000) to 2013 to evaluate the rate of hospitalizations and determine the cost and mortality associated with PH. Conclusion:The number of inpatient discharges related to PH has increased even though the number of inpatient discharges with PAH has been reported to be lower in literature. The mean length of stay has also shown a mild increase. This increase is associated with a significant increase in the mean and aggregate cost. These inpatient costs associated with PH contribute significantly to the total healthcare burden. Further research on cost-effective evaluation and management of PH is required.

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Excess Costs Associated with Patients with Pulmonary Arterial Hypertension in a US Privately Insured Population

Abstract: Patients with PAH had substantially higher costs and co-morbidity than controls, with circulatory/respiratory system-related costs accounting for 40% of excess costs. The high burden of illness suggests opportunities for savings from improved management.

Cited by 45 publications

References 22 publications

Lower Socioeconomic Status Is Associated with Worse Outcomes in Pulmonary Arterial Hypertension

Lower Socioeconomic Status Is Associated with Worse Outcomes in Pulmonary Arterial Hypertension

Impact of Diabetes in Patients with Pulmonary Hypertension

Nationwide Trends in Inpatient Admissions of Pulmonary Hypertension in the United States from 2000 to 2013

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