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 Database®. 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. Total all-cause costs declined from $15,117 per patient per month at baseline to $14,201 after treatment initiation, with decreased medical costs ($14,208 vs. $6,349) more than offsetting increased pharmacy costs ($909 vs. $7,852). In summary, despite growing evidence supporting combination therapy, most members with PAH initiated treatment with monotherapy. Total costs decreased following treatment, driven by a reduction in medical costs even with increases in pharmacy costs.

Keywords: healthcare costs; healthcare resource utilization; pulmonary arterial hypertension; treatment patterns.

Figure 1

Study design. HCRU, healthcare resource utilization; PAH, pulmonary arterial hypertension; RHC, right heart catherization. ¹≥1 claim for a PAH medication during the member selection period (October 1, 2015 and November 30, 2020). The first PAH medication is set as the index date. ²Defined as member's start of continuous enrollment (variable) in database. ³≥1 inpatient or ≥2 outpatient claims on two distinct dates for PAH. ⁴≥1 claim for RHC. ⁵Earliest of disenrollment or end of the study period (December 31, 2020).

Figure 2

PAH medications by treatment line.¹ ERA, endothelin receptor antagonist; IP, inhaled prostacyclin; OP, oral prostacyclin; PAH, pulmonary arterial hypertension; PDE5I, phosphodiesterase 5 inhibitor; PP, parenteral prostacyclin; sGCs, soluble guanylate cyclase stimulators.¹ Sankey diagrams show treatments that comprise ≥1% of total line *n ≤ 10.