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. 2024 Jul 8;14(3):e12399.
doi: 10.1002/pul2.12399. eCollection 2024 Jul.

Association of risk assessment at diagnosis with healthcare resource utilization and health-related quality of life outcomes in pulmonary arterial hypertension

Allan Lawrie  1   2 , Neil Hamilton  3 , Steven Wood  2   4 , Fernando Exposto  5 , Ruvimbo Muzwidzwa  5 , Louise Raiteri  5 , Amélie Beaudet  6 , Audrey Muller  6 , Rafael Sauter  6 , Nadia Pillai  6 , David G Kiely  2   3   7   8 ; ASPIRE Consortium
Collaborators, Affiliations

Association of risk assessment at diagnosis with healthcare resource utilization and health-related quality of life outcomes in pulmonary arterial hypertension

Allan Lawrie et al. Pulm Circ. .

Abstract

We aimed to describe the clinical characteristics, healthcare resource utilization (HCRU) and costs, health-related quality of life (HRQoL), and survival for patients with pulmonary arterial hypertension (PAH), stratified by 1-year mortality risk at diagnosis. Adults diagnosed with PAH at the Sheffield Pulmonary Vascular Disease Unit between 2012 and 2019 were included. Patients were categorized as low, intermediate, or high risk for 1-year mortality at diagnosis. Demographics, clinical characteristics, comorbidities, HCRU, costs, HRQoL, and survival were analyzed. Overall, 1717 patients were included: 72 (5%) at low risk, 941 (62%) at intermediate risk, and 496 (33%) at high risk. Low-risk patients had lower HCRU prediagnosis and 1-year postdiagnosis than intermediate- or high-risk patients. Postdiagnosis, there were significant changes in HCRU, particularly inpatient hospitalizations and accident and emergency (A&E) visits among high-risk patients. At 3 years postdiagnosis, HCRU for all measures was similar across risk groups. Low-risk patients had lower EmPHasis-10 scores (indicating better HRQoL) at diagnosis and at 1-year follow-up compared with intermediate- and high-risk patients; only the score in the high-risk group improved. Median overall survival decreased as risk category increased in analyzed subgroups. Low-risk status was associated with better 1-year survival and HRQoL compared with intermediate- and high-risk patients. HCRU decreased in high-risk patients postdiagnosis, with the most marked reduction in A&E admissions. The pattern of decreased per-patient inpatient hospitalizations and A&E visits at 3 years postdiagnosis suggests that a diagnosis of PAH helps to decrease HCRU in areas that are key drivers of costs.

Keywords: healthcare resource utilization; health‐related quality of life; pulmonary arterial hypertension; real‐world evidence; risk assessment.

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Conflict of interest statement

Allan Lawrie is supported by a British Heart Foundation Senior Basic Science Research Fellowship (FS/18/52/33808) and has received honoraria and funding from Janssen Pharmaceuticals to attend scientific meetings. Amélie Beaudet, Audrey Muller, Rafael Sauter, and Nadia Pillai are employees of Actelion Pharmaceuticals Ltd. Amélie Beaudet and Audrey Muller own stock in Johnson & Johnson. Neil Hamilton has received honoraria payments from Janssen Pharmaceuticals, Vifor Pharmaceuticals, and MSD. David G. Kiely has received grants from Janssen Pharmaceuticals and Ferrer; consulting fees from Janssen Pharmaceuticals, MSD, Ferrer, Altavant, and United Therapeutics; honoraria from Janssen Pharmaceuticals, MSD, Ferrer, and United Therapeutics; funding from Janssen Pharmaceuticals, MSD, and Ferrer to attend scientific meetings; has participated in a Data Safety Monitoring Board or Advisory Board for Janssen Pharmaceuticals and MSD; serves on the Specialist Respiratory Clinical Reference Group (unpaid) and as the UK National Audit Chair. Steven Wood has received grants from Janssen Pharmaceuticals in support of the current study. The remaining authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Overview of observation times and database coverage in the study. HCRU, healthcare resource utilization; HES, Hospital Episode Statistics; HRQoL, health‐related quality of life; Sheffield PVDU, Sheffield Pulmonary Vascular Disease Unit.
Figure 2
Figure 2
Comorbidities recorded as present in the 5 years before pulmonary arterial hypertension diagnosis overall and by risk group. Data were collected from the Hospital Episode Statistics database. In almost all categories for low‐risk patients, there were <7 patients, which meant data suppression applied. Renal failure comprised International Classification of Diseases, 10th Revision, codes I12.0, I13.1, I13.2, K76.7, N17, N18.4, N18.5, N19, N99.0, O08.4, O90.4, T86.1, Y84.1, and Z99.2. COPD, chronic obstructive pulmonary disease.
Figure 3
Figure 3
Median and mean all‐cause healthcare resource utilization (HCRU) episodes per patient per year, 1 year before and 1 and 3 years* after pulmonary arterial hypertension diagnosis, by risk group. *HCRU at 3 years postdiagnosis represents median and mean values per year of follow‐up over 3 years for patients with available follow‐up data, not the median and mean during the third year only.
Figure 4
Figure 4
Median cost per patient per year of follow‐up, (a) 1 year and (b) 3 years postdiagnosis by risk group. A&E, accident and emergency.
Figure 5
Figure 5
Median EmPHasis‐10 (E10) scores at diagnosis and 1‐year postdiagnosis, overall and by risk group at diagnosis. Only patients with assessments at both time periods are included in the figure. The E10 is an instrument developed and validated specifically for assessment of health‐related quality of life (HRQoL) in patients with pulmonary hypertension., Higher scores are indicative of worse HRQoL.
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