Economic burden of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) in Finland

Abstract

Objectives: Given that pulmonary arterial hypertension (PAH) and chronic thromboembolic hypertension (CTEPH) are rare yet severe subtypes of pulmonary hypertension significantly impacting patients' lives, this study analyzed the total societal costs of these conditions in Finland.

Methods: PAH (n = 247) and CTEPH (n = 177) patients diagnosed between 2008 and 2019 were analyzed for primary and specialty outpatient visits, emergency visits, hospitalizations, home and institutional care, sick leaves, disability pensions, and drug costs for 5 years before and after diagnosis.

Results: In PAH and CTEPH, annual specialty care number of outpatient visits increased from 3.8 and 3.3 (5 years before diagnosis) to 13.8 and 9.5 one-year post-diagnosis, then decreased to 9.2 and 4.0 at 5 years post-diagnosis. Annual inpatient days rose from 2.8 and 2.7 to 16.1 and 19.7 pre-diagnosis, then fell to 10.2 and 3.5 post-diagnosis, respectively. Within 5 years post-diagnosis, in working-age 70 % PAH and 42 % CTEPH patients received disability pensions. Drug therapy accounted for most costs (67 % in PAH and 60 % in CTEPH), followed by inpatient care, disability pensions, and outpatient care. Total costs were significantly lower for CTEPH, especially after pulmonary endarterectomy. Among PAH subtypes, the highest costs were in patients with PAH associated with connective tissue diseases.

Conclusions: PAH and CTEPH cause a significant economic burden on patients and society with considerable differences depending on the PAH subtype and whether the patient has undergone PEA operation or not.

Keywords: Chronic thromboembolic pulmonary hypertension; Healthcare cost; Healthcare resource use; Pulmonary arterial hypertension.

Fig. 1

Healthcare resource use of the PAH and CTEPH patients 5 years before and 5 years after the diagnosis. Mean number of (A) primary outpatient care visits, (B) specialty care outpatient visits, (C) emergency department visits, and (D) days spent hospitalized per patient annually. The analysis includes only surviving patients with complete follow‐up data per year. Emergency department visits and inpatient days included both primary and specialty care visits and days, respectively. P-value denotes the significance of the longitudinal trend in analyzed HCRU over the five-year period following diagnosis (years + 1 to + 5). P-values with dark blue shown for PAH patients and with light blue for CTEPH patients.

Fig. 2

PAH-specific and supportive therapy drug use of the patients 5 years before and 5 years after the diagnosis for PAH and CTEPH patients. PAH-specific: ERA, Endothelin receptor antagonists; PDE5, Phosphodiesterase 5 inhibitors; GCS, Guanylate cyclase stimulator; PCA, Prostacyclin analogues; PRA, Prostacyclin receptor antagonist; supportive therapy: diuretics, anticoagulation, digoxin, antiplatelet.

Fig. 3

Annual sick leaves and disability pensions of the patients 5 years before and 5 years after the diagnosis. Mean annual number of (A) sick leave days per patient, and annual proportion of patients on disability pension (B).

Fig. 4

Total annual costs of the patients by category 5 years before and 5 years after the diagnosis. P-value denotes the significance of the longitudinal trend in total annual costs over the five-year period following diagnosis (years + 1 to + 5).