The economic burden of pulmonary arterial hypertension (PAH) in the US on payers and patients

Abstract

Background: Pulmonary arterial hypertension (PAH) is a rare condition that can ultimately lead to right heart failure and death. In this study we estimated the health care costs and resource utilization associated with PAH in a large US managed care health plan.

Methods: Subjects with claims-based evidence of PAH from 1/1/2004 to 6/30/2010 (identification period) were selected. To be included in the final PAH study sample, subjects were required to have ≥2 claims with a primary PH diagnosis; ≥2 claims with a PAH related-diagnosis (connective tissue diseases, congenital heart diseases, portal hypertension); and ≥1 claim with evidence of a PAH-indicated medication. The earliest date of a claim with evidence of PAH-indicated medication during the identification period was set as the index date. Health care costs and resource utilization were compared between an annualized baseline period and a 12 month follow-up period.

Results: 504 PAH subjects were selected for the final study cohort. Estimated average total health care costs were approximately 16% lower in the follow-up period compared to the baseline period (follow-up costs = $98,243 [SD = 110,615] vs. baseline costs = $116,681 [SD = 368,094], p < 0.001), but substantively high in each period relative to costs reported for other chronic diseases. Pharmacy costs were significantly higher in the follow-up period vs. the baseline period, ($38,514 [SD = 34,817] vs. $6,440 [SD = 12,186], p < 0.001) but medical costs were significantly lower in the follow-up vs. baseline ($59,729 [SD = 106,683] vs. $110,241 [SD = 368,725], p < 0.001). These costs were mirrored in health-care resource utilization estimates. The average counts of ambulatory visits and inpatient stays were lower in the follow-up vs. the baseline (both p < 0.001). Results varied in exploratory analyses when less restrictive subject identification algorithms were used.

Conclusions: Subjects with evidence of PAH had substantively high health care costs. Medical costs appeared to decrease following PAH medication use, but with a concomitant increase in pharmacy costs.

Figure 1

Selection of subjects with PAH.

Figure 2

Average health care costs (annualized baseline and 12 month follow-up). Differences in costs between baseline and follow-up were statistically significant (p < 0.001) for all categories, with the exception of ER costs (p = 0.700). Bars represent standard deviation.

Figure 3

Average health plan and patient paid health care costs (annualized baseline and 12 month follow-up). For health plan paid costs, differences in costs between baseline and follow-up were statistically significant (p < 0.001) for all categories, with the exception of ER costs (p = 0.653). For patient paid costs, differences in costs between baseline and follow-up were statistically significant (p < 0.001) for all categories, with the exception of total costs (p = 0.989) and ER costs (p = 0.758). Bars represent standard deviation.

Figure 4

PAH medication use (12 month follow-up).

Figure 5

PAH medication group and PAH diagnosis group average annual health care costs (exploratory analysis). For PAH medication group, differences in costs between baseline and follow-up were statistically significant (p < 0.01) for all categories. For PAH diagnosis group, differences in costs between baseline and follow-up were statistically significant (p < 0.001) for all categories. Bars represent standard deviation.