Real‐world treatment patterns, healthcare resource utilization, and cost among adults with pulmonary arterial hypertension in the United States

Abstract

Treatment for pulmonary arterial hypertension (PAH) has evolved over the past decade, including approval of new medications and growing evidence to support earlier use of combination therapy. Despite these changes, few studies have assessed real-world treatment patterns, healthcare resource utilization (HCRU), and costs among people with PAH using recent data. We conducted a retrospective cohort study using administrative claims from the HealthCore Integrated Research Data-base®. Adult members with claims for a PAH diagnosis, right heart catheterization, and who initiated PAH treatment (index date) between October 1, 2015 and November 30, 2020 were identified. Members had to be continuously enrolled in the health plan for 6 months before the index date (baseline) and ≥30 days after. Treatment patterns, HCRU, and costs were described. A total of 843 members with PAH (mean age 62.3 years, 64.2% female) were included. Only 21.0% of members received combination therapy as their first-line treatment, while most members (54.6%) received combination therapy as second-line treatment. All-cause HCRU remained high after treatment initiation with 58.0% of members having ≥1 hospitalization and 41.3% with ≥1 emergency room visit.

Assessment of Knowledge, Attitude, and Practice Patterns in Pulmonary Arterial Hypertension among Cardiologists and Pulmonologists: Evidence from Turkey

“…As for treatment preferences, our participants mostly preferred monotherapy (82.8%) for patients with mild/moderate PAH diagnosed with a negative vasoreactivity test, and ERAs were the most preferred in this group. Similarly, in real-world data involving newly diagnosed USA patients with PAH, nearly 94% of patients commenced treatment with monotherapy and the most common treatment preference were PDE-5 inhibitors (70.0% of patients) [21]. Preston et al found in their study that a significant proportion of patients were treated with PDE-5 inhibitors in Argentina and the USA, whereas in Europe, an equal proportion of patients were treated with PDE-5 inhibitors and ERAs [13].…”

Societal costs associated with pulmonary arterial hypertension: A study utilizing linked national registries

“…That a debilitating disease like PAH have high HCRU after diagnosis is neither surprising nor unknown, 9 , 10 , 11 , 12 , 15 , 16 , 17 however, the costs for society before diagnosis is less studied 10 , 17 , 31 , 32 and the magnitude of productivity loss has not been shown before. Hospitalizations as a substantial cost driver after the PAH diagnosis 10 , 11 , 15 , 16 , 17 was confirmed by the present study and, importantly, productivity loss was found to be equally costly.…”

“…Previous studies have shown diverging results of the main post‐diagnosis cost driver as being either related to drug costs 10,31,32 or to nondrug related healthcare costs 14–16 . This discrepancy might relate to that a majority of the previous studies are based on patients identified from insurance claim databases or databases using criteria such as treatment, procedures, hospitalization, and/or ICD‐codes and often include both prevalent and incident patients 10,11,14 .…”

Economic Burden of Delayed Diagnosis in Patients with Pulmonary Arterial Hypertension (PAH)

“…As such, this study provides important context to the findings of previous studies on the economic burden of PAH overall. Prior evidence indicates that diagnosed PAH is associated with a substantial economic burden in the US [ 17 – 21 ]. In a retrospective administrative claims-based study of patients with diagnosed PAH in the US from 2015 to 2020, mean total all-cause health care costs after PAH treatment initiation (mean follow-up of 1.5 years) were US$14,201 PPPM [ 21 ], which is consistent with the mean total all-cause health care costs obtained in our overall sample (US$14,129 PPPM).…”

“…Prior evidence indicates that diagnosed PAH is associated with a substantial economic burden in the US [ 17 – 21 ]. In a retrospective administrative claims-based study of patients with diagnosed PAH in the US from 2015 to 2020, mean total all-cause health care costs after PAH treatment initiation (mean follow-up of 1.5 years) were US$14,201 PPPM [ 21 ], which is consistent with the mean total all-cause health care costs obtained in our overall sample (US$14,129 PPPM). Previous studies further suggest that hospitalizations are the main driver of the substantial HRU and cost burden among patients with PAH [ 6 , 18 , 20 , 22 – 28 ].…”