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

Abstract

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.

Effectiveness and safety of a simple home-based rehabilitation program in pulmonary arterial hypertension: an interventional pilot study

“…The main goals of PAH therapy are to ensure an acceptable level of quality of life in the earliest stages of the disease, reduce disease progression, and improve patient prognosis [ 4 , 5 ], which remains poor [ 6 , 7 ]. The European Respiratory Society/European Cardiology Society (ERS/ESC) guidelines published in 2015 recommend the implementation of monitored individualized exercise training as adjuvant therapy for stable PAH patients on optimal medical treatment [ 8 ].…”

Oral Prostacyclin Pathway Agents Used in PAH: A Targeted Literature Review

“… 47 In a retrospective cohort study using the IBM MarketScan database, Dean et al studied patients aged ≥18 years receiving selexipag (n = 126) or oral treprostinil (n = 130). At month 6, the mean number of inpatient visits was similar between treatment groups (adjusted all-cause inpatient visits: 1.3 ± 0.6 [oral treprostinil] vs 1.9 ± 0.8 [selexipag] (P = 0.2); 48 and adjusted PAH-related inpatient visits: 1.2 ± 0.6 vs 1.2 ± 0.6, respectively; P = 1.0). After adjusting for covariates, treatment with selexipag was associated with 51.4% higher total all-cause healthcare costs versus oral treprostinil, predominantly attributable to all-cause pharmacy costs (68.2% higher in patients receiving selexipag compared with those receiving oral treprostinil).…”

Comparison of Healthcare Encounters and Drug Persistence in Patients With Pulmonary Arterial Hypertension Receiving Oral Selexipag, Inhaled Iloprost, or Parenteral Treprostinil: A Retrospective Database Analysis

“…The start date of the identification period Figure 1. Study Design allowed for a baseline period of at least 6 months before the index date to capture patients' clinical characteristics, including pulmonary hypertension (PH) diagnoses, comorbidities, and prior medication use; the same duration of baseline period was used by McConnell et al 9 and Dean et al 10 in their published retrospective database analyses of selexipag vs oral treprostinil. The follow-up period for each patient was from their index date until the earliest of discontinuation of index drug, initiation of oral or inhaled treprostinil (formulations of treprostinil available only in the United States 11 ) or epoprostenol, health plan disenrollment, death, or the end of the study period.…”