Healthcare burden of pulmonary hypertension owing to lung disease and/or hypoxia

Abstract

BackgroundGroup 3 pulmonary hypertension (PH) encompasses PH owing to lung diseases and/or hypoxia. Treatment patterns, healthcare resource use, and economic burden to US payers of Group 3 PH patients were assessed.MethodsThis retrospective observational study extracted data from July 1, 2010 to June 30, 2013 from two Truven Health Analytics MarketScan databases. Adult Group 3 PH patients were identified based on claims for PH (ICD-9-CM 416.0/416.8), a related lung disease, and an echocardiogram or right heart catheterization (RHC). The index date was the date of the first PH claim; data were collected for 12 months pre- and post-index. A difference-in-difference approach using generalized estimating equations was done to account for baseline differences.ResultsGroup 3 PH patients (n = 2,236) were matched 1:1 to controls on lung disease. PH patients had higher all-cause resource utilization and annual healthcare costs ($44,732 vs. $7,051) than controls. Costs were driven by inpatient admissions (35.4% of total costs), prescriptions (33.0%), and outpatient care (26.5%). Respiratory-related costs accounted for 11.4% of post-index annual costs for PH patients. PH diagnosis was not confirmed in the majority of PH patients (<7% RHC use) but nevertheless, 22% of PH patients post-index had claims for drugs approved for the treatment of pulmonary arterial hypertension (PAH).ConclusionsGroup 3 PH poses a significant clinical and economic burden. Given the low use of RHC and the prevalence of PAH-indicated prescriptions that are not currently approved for Group 3 PH, this study suggests some Group 3 PH patients may not be receiving guideline-recommended treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-017-0399-1) contains supplementary material, which is available to authorized users.

Healthcare utilisation and costs in the diagnosis and treatment of progressive-fibrosing interstitial lung diseases

“…The likely elevation of healthcare utilisation in patients with ILD arises in part from comorbidities in patients with ILD that include cardiovascular disease, malignancy, sleep apnoea and pulmonary hypertension (PH), and contribute to hospitalisations, physician visits and medication use [6,49,50]. Again, using the example of IPF, in a recent analysis of healthcare costs and utilisation in patients covered by Medicare in the USA, it was estimated that the total annual medical costs in 2000-2011 were up to USD 3 billion, of which USD 1.8 billion was attributable to IPF and associated comorbidities [13].…”

“…Again, using the example of IPF, in a recent analysis of healthcare costs and utilisation in patients covered by Medicare in the USA, it was estimated that the total annual medical costs in 2000-2011 were up to USD 3 billion, of which USD 1.8 billion was attributable to IPF and associated comorbidities [13]. For example, World Health Organization group 3 PH is associated with substantially higher healthcare resource use than in control disease-matched patients, particularly in the number of prescription claims, outpatient visits and physician office visits [49]. Prevalence rates of comorbidities in IPF have been published with wide ranges, for example: PH 8-84%; cardiac disease 60%; lung cancer 4.4-10%; and sleep apnoea, 60-90% [49,50].…”

“…For example, World Health Organization group 3 PH is associated with substantially higher healthcare resource use than in control disease-matched patients, particularly in the number of prescription claims, outpatient visits and physician office visits [49]. Prevalence rates of comorbidities in IPF have been published with wide ranges, for example: PH 8-84%; cardiac disease 60%; lung cancer 4.4-10%; and sleep apnoea, 60-90% [49,50]. Based on a small number of results, rates of comorbidities in patients with other progressive-fibrosing ILDs may be similar to those in IPF.…”

The incremental shuttle walk test predicts mortality in non‐group 1 pulmonary hypertension: results from the ASPIRE Registry

“…43 Nonetheless, studies have shown a significant number of these patients do receive PAH-targeted therapies 44,45 and the need to evaluate therapies in groups 2 and 3 has been highlighted. 44–47 We have demonstrated that the ISWT is a useful tool for assessing exercise capacity for clinical monitoring and may have utility as an endpoint in trials of targeted therapies for non-group 1 PH.…”

Financial Toxicity: A Common but Rarely Discussed Treatment Side Effect

“…Evaluating inhaler use among older adults with chronic obstructive pulmonary disease and/or asthma, Castaldi and colleagues noted that an OOP expense greater than $20 per month was associated with costrelated nonadherence to inhaler therapy compared with patients with no OOP inhaler costs (11). Another study found that among patients with group 3 pulmonary hypertension, prescription medication comprised 33% of healthcare spending, second to inpatient hospitalizations (35.4%) but more than the 26.5% attributed to outpatient care (12). Although pharmacy benefit managers can help patients with IPF manage the high cost of medications such as nintedanib and pirfenidone (13), to date there are no published studies evaluating how the costs of IPF medications directly affect patients and their families.…”