Healthcare Utilization and Costs associated with Hereditary Hemorrhagic Telangiectasia Patients in a Large US Claims Database

Abstract

Objective: To assess the health care costs and utilization in patients with hereditary hemorrhagic telangiectasia (HHT) in the United States.

Patients and methods: Retrospective analysis of patients with HHT diagnosed between 2007 and 2017 was performed using deidentified administrative claims data from the OptumLabs Data Warehouse. Adult patients with new (incident) diagnosis of HHT between January 1, 2007, and December 31, 2017, were included. Comparisons were made using the Wilcoxon rank sum test.

Results: Three thousand nine hundred seventy-seven patients with a first diagnosis of HHT between 2007 and 2017 were identified, of which 3590 were matched 1:1 to non-HHT patients with similar baseline characteristics and comorbidities. These 3590 patients with HHT were 63.1% female and 83.9% white with a mean age of 51.1 ± 18.5 years, and a mean follow-up period of 3.2 ± 2.2 years (range, 1.0-11.7 years). Compared with the control group, the cumulative 5-year median total health care cost for patients with HHT was 41.4% higher ($21,118 vs $14,929; P < .001) in those with private commercial insurance and 31.7% higher ($35,462 vs $26,925; P < .001) in those with Medicare Advantage coverage. The median annual health care costs were significantly higher in patients with HHT with commercial insurance and Medicare Advantage in the first year after diagnosis ($4,333 vs $1,804; P < .001), and ($7,322 vs $5,245; P < .001), respectively, and remained higher throughout the duration of follow-up. Further analysis showed that outpatient clinic visits, hospital admission, imaging rates, invasive procedures, iron infusions, and blood transfusions were all significantly higher in the HHT group.

Conclusion: Patients with HHT have significantly higher health care costs compared with a matched control group. A better understanding of the reasons underlying these cost differences will provide opportunities for patients, providers, and other stakeholders to better manage this rare condition.

Keywords: AVM, arteriovenous malformation; CT, computed tomography; GI, gastrointestinal; HHT, hereditary hemorrhagic telangiectasia; ICD, International Classification of Diseases; MRI, magnetic resonance imaging; OLDW, OptumLabs Data Warehouse.

Figure 1

Annual health care cost of patients with hereditary hemorrhagic telangiectasia (HHT) compared with matched controls. This figure shows the median annual total cost of care for patients with HHT compared with matched controls. The total cost was the highest 1 year after establishing the diagnosis, and it remained higher than in controls each year up to 5 years after the diagnosis in both patients with Medicare Advantage and commercial health care plans.

Figure 2

Office visit rates in patients with hereditary hemorrhagic telangiectasia (HHT) compared with matched controls. This figure shows office visit rates per 1000 patients. Patients with HHT had significantly higher rates of outpatient clinic visits in both patients with commercial insurance and Medicare Advantage extending up to 5 years after the diagnosis.

Figure 3

Increased utilization rate ratios in the peri-diagnosis period in patients with hereditary hemorrhagic telangiectasia (HHT) and commercial insurance compared with matched controls. This figure shows utilization rate ratios for patients with HHT and matched controls with private insurance in the peri-diagnosis period (calculated as rates 1 year after diagnosis divided by rates 1 year before diagnosis). This figure shows a significant increase in utilization of outpatient office visits, hospitalizations, imaging, and procedures (including iron and blood transfusions).