Healthcare resource utilization and costs for patients with pulmonary arterial hypertension: real-world documentation of functional class

Dufour, Robert; Pruett, Janis; Hu, Nan; Lickert, Cassandra A.; Stemkowski, Stephen; Tsang, Yuen; Lane, Daniel C.; Drake, William

doi:10.1080/13696998.2017.1363049

Cited by 30 publications

(38 citation statements)

References 17 publications

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“…The 5-year survival in patients with PAH ranges from 59 to 68% [3][4][5]. Various risk score calculators have been developed for predicting contemporary survival [6][7][8][9], and certain indicators, including B-type natriuretic peptide, N-terminal pro B-type natriuretic peptide, functional status, and 6-minute walk distance, are predictors of outcomes and survival [5,10,11].…”

Section: Introductionmentioning

confidence: 99%

Medication Adherence and Healthcare Costs Among Patients with Pulmonary Arterial Hypertension Treated with Oral Prostacyclins: A Retrospective Cohort Study

Dean

Saundankar

Stafkey-Mailey

et al. 2020

Drugs - Real World Outcomes

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Background Given the improved convenience of oral prostacyclins, there is a shift toward their use in treating pulmonary arterial hypertension (PAH). Objectives Our objective was to compare patient characteristics, medication adherence, healthcare resource use (HCRU), and costs among patients receiving oral treprostinil or selexipag. Methods We used Truven Health MarketScan Commercial and Medicare databases to identify patients with PAH with a diagnosis code for pulmonary hypertension (PH) plus a prescription for oral treprostinil or selexipag from July 2013 to September 2017. Medication adherence, persistence, and all-cause and PAH-related HCRU and costs were compared between cohorts during the 6-month follow-up. Adjusted healthcare costs were obtained using recycled predictions and bootstrapped samples. Results A total of 256 (130 oral treprostinil, 126 selexipag) patients fulfilled the study criteria. The oral treprostinil cohort was more likely to be male, to have previously used parenteral prostacyclins, and to have higher outpatient costs at baseline than the selexipag cohort. During follow-up, both cohorts had similar proportions of patients who were adherent to and persistent with their respective therapies. All-cause and PAH-related medical utilization was generally similar between cohorts. The oral treprostinil cohort had 66.9% lower total PAH-related healthcare costs (mean difference − $75,183; 95% confidence interval [CI] − 102,584 to − 49,771) and 70.6% lower PAH-related pharmacy costs (mean difference − $76,439; 95% CI − 104,512 to − 51,458) than the selexipag cohort, with similar differences in all-cause healthcare and pharmacy costs. Conclusions Lower all-cause and PAH-related total healthcare and pharmacy costs were observed in patients receiving oral treprostinil compared with those receiving selexipag. It will be important to study longer-term costs and clinical outcomes.

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Section: Introductionmentioning

confidence: 99%

Medication Adherence and Healthcare Costs Among Patients with Pulmonary Arterial Hypertension Treated with Oral Prostacyclins: A Retrospective Cohort Study

Dean

Saundankar

Stafkey-Mailey

et al. 2020

Drugs - Real World Outcomes

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“…Mean total health care costs for patients with PAH were higher than costs for a Centers for Medicare and Medicaid Services managed care control group and increased with more severe baseline FC, with patients in FC IV having the highest costs [6]. Health care resource utilization, including inpatient admissions, longer average lengths of stay, and emergency department visits, was also greater for patients with FC IV than other FC subgroups [6]. In another study, patients with severe PAH who received medical therapy alone were more likely to have more severe FC (III/IV), which was associated with greater health care resource utilization compared with patients who received exercise training plus medical therapy [53].…”

Section: Fc and Economic Outcomesmentioning

confidence: 80%

Section: Fc and Economic Outcomesmentioning

confidence: 89%

“…With an estimated prevalence of 10.6-12.4 cases per million [1], pulmonary arterial hypertension (PAH) is a rare chronic and progressive disease characterized by increased pulmonary vascular resistance that can result in death due to right heart failure [2]. Numerous available treatments for PAH [3] have been evaluated in clinical trials using a variety of endpoints [4][5][6]. In the past two decades, PAH study design and duration shifted from short-term trials assessing noninvasive endpoints to long-term event-driven trials [7,8].…”

Section: Introductionmentioning

confidence: 99%

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The Role of Noninvasive Endpoints in Predicting Long-Term Outcomes in Pulmonary Arterial Hypertension

Wronski

Mordin

Kelley³

et al. 2019

Lung

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Background Until recently, many clinical trials in patients with pulmonary arterial hypertension (PAH) evaluated exercise capacity with 6-minute walk distance (6MWD) as the primary endpoint. Common secondary endpoints include PAH functional class (FC), which assesses symptoms, and either brain natriuretic peptide (BNP) or the inactive N-terminal cleavage product of its prohormone (NT-proBNP), which assesses cardiac function. Objective Examine the relationships among 6MWD, FC, and BNP/NT-proBNP measured at baseline or follow-up with long-term outcomes in PAH studies. Methods Relevant literature from January 1990 to April 2018 were obtained by searching PubMed, Embase, and Cochrane. Articles in English reporting on associations between 6MWD, FC, or BNP/NT-proBNP and outcomes in PAH were identified. Each endpoint was evaluated individually. Prespecified inclusion and exclusion criteria were applied at level 1 (titles/ abstracts) and level 2 (full-text review). Results The database search yielded 836 unique records; 65 full-text articles were reviewed. Twenty-five studies were eligible for inclusion. Findings supported the importance of measuring PAH noninvasive endpoints in predicting longterm outcomes. Patients with shorter or decreased 6MWD, poor (III/IV) or declining FC (e.g., from II to III), or elevated or increasing BNP/NT-proBNP had a higher risk of death and costly events (e.g., hospitalization, lung transplant). FC also predicted health care resource utilization and costs. Collectively, these endpoints establish risk groups that predict likelihood of complications from PAH or death. Conclusion Assessment of 6MWD, FC, and BNP/NT-proBNP provides low-cost, efficient, and noninvasive means of predicting long-term health and economic outcomes in patients with PAH.

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“…14,23 A retrospective database study showed PAH (FC II-IV) patients had high healthcare resource utilization with annual pharmacy costs 17 to 21 times higher and medical costs 10 to 11 times higher than the average Medicare patient. 24 A prospective analysis of newly diagnosed PAH patients from REVEAL showed a substantial burden of disease with a 57% incidence of all-cause hospitalization (52% PAHrelated) and worse survival at 3 years. 25 Those charged with making managed care formulary decisions which optimize the care of patients and manage resources, are searching for ways to offset high costs.…”

mentioning

confidence: 99%

Using Real World Evidence to Describe Pulmonary Arterial Hypertension Treatment Patterns, Healthcare Resource Utilization, and Costs Associated with PDE-5 Inhibitor Monotherapy

Ruiz

Yeaw

Lickert

et al. 2018

JHEOR

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Background: Pulmonary arterial hypertension (PAH) is described by proliferation of small pulmonary arteries leading to increased pulmonary vascular resistance, right ventricular failure, and death. Research confirms long-term improvement in composite morbidity and mortality endpoints on some endothelin receptor antagonists alone and in combination with phosphodiesterase type 5 inhibitors (PDE-5is) but not with PDE-5i monotherapy. While current treatment guidelines incorporate these findings, a substantial number of patients are started or maintained on PDE-5i monotherapy.</p> Objectives: This study describes real-world clinical practice and treatment patterns with PDE-5i monotherapy including events indicative of clinical worsening, treatment modifications, adherence, allcause healthcare resource utilization, and costs. Methods: This retrospective study analyzed PharMetrics Plus claims data including 150 million lives; study period was January 1, 2009 through December 31, 2013. Eligible patients were ≥18 years with ≥1 inpatient or ≥2 outpatient claims ≥30 days apart, a diagnosis of pulmonary hypertension or other chronic pulmonary heart disease, and an initial PDE-5i prescription. To include only World Health Organization group 1 PAH patients, ≥1 encounter for right-heart catheterization or Doppler echocardiogram was required during the pre-index period. Results: PDE-5i monotherapy for PAH treatment was associated with high treatment modification rates, low adherence, increased healthcare resource utilization, and high costs. At 12 months post index, 41.5% of patients experienced treatment modification. For the index therapy, 47% of patients had ≥80% adherence to therapy. Almost 50% of patients had ≥1 hospitalization, with costs increased three fold to $197 111 compared to $59 164 for non-hospitalized patients. Conclusions: Initial treatment with PDE-5i monotherapy was associated with substantial direct medical costs, including hospitalizations and emergency department visits, low therapy adherence and a high rate of treatment modifications.

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Healthcare resource utilization and costs for patients with pulmonary arterial hypertension: real-world documentation of functional class

Abstract: Using administrative data to document disease severity, this study replicates and expands on findings obtained from the registry study; disease severity was associated with higher healthcare resource utilization and costs. Stakeholders' implications for patient management are discussed.

Cited by 30 publications

References 17 publications

Medication Adherence and Healthcare Costs Among Patients with Pulmonary Arterial Hypertension Treated with Oral Prostacyclins: A Retrospective Cohort Study

Medication Adherence and Healthcare Costs Among Patients with Pulmonary Arterial Hypertension Treated with Oral Prostacyclins: A Retrospective Cohort Study

The Role of Noninvasive Endpoints in Predicting Long-Term Outcomes in Pulmonary Arterial Hypertension

Using Real World Evidence to Describe Pulmonary Arterial Hypertension Treatment Patterns, Healthcare Resource Utilization, and Costs Associated with PDE-5 Inhibitor Monotherapy

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