Abstract
Background
Pulmonary arterial hypertension (PAH) is a rare but fatal disease. Little is known about the economic burden associated with PAH patients in the US.
Objectives
The objective of this study was to estimate excess direct costs associated with privately insured PAH patients in the US.
Methods
From a privately insured claims database (>8 million beneficiaries, 2002–7), 471 patients with PAH were identified using the criteria: two or more claims for primary pulmonary hypertension (PH), International Classification of Diseases, ninth edition, clinical modification (ICD-9-CM) code 416.0; no left heart disease, lung diseases, chronic thromboembolic PH or miscellaneous PH diagnoses within 12 months prior or 1 month after the initial PH claim (index date); one or more claim for right heart catheterization (RHC) within 6 months prior to any PH claim or one or more claim for echocardiogram within 6 months prior to a specialist-diagnosed PH claim; aged 18–64 years. Patients with PAH were matched demographically to controls without PH. Patients were followed as long as continuously eligible; mean follow-up of PAH patients was 24.8 months. Chi-squared tests were used to compare baseline co-morbidities. Wilcoxon rank-sum tests were used to compare direct (medical and pharmaceutical) patient-month costs to insurers.
Results
The average age for PAH patients was 52.2 years, and 55.8% were women. Compared with controls, PAH patients had significantly higher baseline rates of co-morbidities (e.g. essential hypertension, diabetes mellitus and congestive heart failure) and a higher mean Charlson Co-morbidity Index score. Mean direct patient-month costs (year 2007 values) were $US2023 for PAH patients and $US498 for controls (p< 0.0001), yielding excess costs of $US1525. Sensitivity analysis restricting the sample to patients diagnosed following RHC yielded a 64% increase in excess costs relative to the original sample. Regarding cost drivers, inpatient services accounted for 45%, outpatient and other services for 38% and prescription drugs for 15% of total direct healthcare costs per patient-month in PAH patients. Circulatory/respiratory system-related patient-month costs were $US724 among PAH patients and $US114 among controls (p< 0.0001).
Conclusions
Patients with PAH had substantially higher costs and co-morbidity than controls, with circulatory/respiratory system-related costs accounting for 40% of excess costs. The high burden of illness suggests opportunities for savings from improved management.
Similar content being viewed by others
References
McLaughlin VV, Archer SL, Badesch DB, et al. AC-CF/AHA 2009 expert consensus document on pulmonary arterial hypertension. J Am Coll Cardiol 2009; 53(17): 1573–619
Thenappan T, Shah SJ, Rich S, et al. A USA-based registry for pulmonary arterial hypertension: 1982–2006. Eur Respir J 2007; 30: 1103–10
Peacock AJ. Treatment of pulmonary hypertension. BMJ 2003; 326: 835–6
Galie N, Manes A, Branzi A. Emerging medical therapies for pulmonary arterial hypertension. Prog Cardiovasc Dis 2002; 45(3): 213–24
Benedict N, Seybert A, Mathier M. Evidence-based pharmacologic management of pulmonary arterial hypertension. Clin Ther 2007; 29(10): 2134–53
Murali S. Pulmonary arterial hypertension. Curr Opin Crit Care 2006; 12: 228–34
Simonneau G, Galie N, Rubin LJ, et al. Clinical classification of pulmonary hypertension. J Am Coll Cardiol 2004; 43: 5–12S
Simonneau G, Robbins IM, Beghetti M, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2009 Jun 30; 54(1 Suppl.): S43–54
National Institute for Health and Clinical Excellence. Clinical and cost effectiveness of treatments for pulmonary arterial hypertension (PAH) within their licensed indications. London: NICE, 2007 [online]. Available from URL: http://www.nice.org.uk/nicemedia/pdf/PAHassessmentreport.pdf [Accessed 2009 Nov 20]
Michelakis ED, Tymchak W, Noga M, et al. Long-term treatment with oral sildenafil is safe and improved functional capacity and hemodynamics in patients with pulmonary arterial hypertension. Circulation 2003; 108(17): 2066–9
Hoeper MM, Faulenbach C, Golpon H, et al. Combination therapy with bosentan and sildenafil in idiopathic pulmonary arterial hypertension. Eur Respir J 2004; 24(6): 1007–10
Angalakuditi M, Edgell E, Beardsworth A, et al. Treatment patterns and resource utilization and costs among patients with pulmonary arterial hypertension in the United States. J Med Econ 2010; 13(3): 393–402
Peacock AJ, Murphy NF, McMurray JJV, et al. An epidemiological study of pulmonary arterial hypertension. Eur Respir J 2007; 30: 104–9
Chin KM, Rubin LJ. Pulmonary arterial hypertension. J Am Coll Cardiol 2008; 51: 1527–38
Champion HC, Michelakis ED, Hassoun PM. Comprehensive invasive and noninvasive approach to the right ventricle pulmonary circulation unit: state of the art and clinical and research implications. Circulation 2009; 120: 992–1007
Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40(5): 373–83
Romano PS, Roos LL, Jollis J. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data. J Clin Epidemiol 1993; 46(10): 1075–9
US Department of Labor, Bureau of Labor Statistics. Consumer price index for medical care services, 2009 [online]. Available from URL: http://www.bls.gov/cpi/ [Accessed 2009 Nov 23]
Einarson TR, Granton JT, Vicente C, et al. Cost-effectiveness of treprostinil versus epoprostenol in patients with pulmonary arterial hypertension: a Canadian analysis. Can Respir J 2005 Nov-Dec; 12(8): 419–25
Wilkens H, Grimminger F, Hoeper M, et al. Burden of pulmonary arterial hypertension in Germany. Respir Med 2010 Jun; 104(6): 902–10
Macchia A, Marchioli R, Marfisi R, et al. A meta-analysis of trials of pulmonary hypertension: a clinical condition looking for drugs and research methodology. Am Heart J 2007; 153: 1037–47
Ghofrani HA, Wilkins MW, Rich S. Uncertainties in the diagnosis and treatment of pulmonary arterial hypertension. Circulation 2008; 118: 1195–201
Galiè N, Palazzini M, Manes A. Pulmonary arterial hypertension: from the kingdom of the near-dead to multiple clinical trial meta-analyses. Eur Heart J 2010 Sep; 31(17): 2080–6
Chen YF, Jowett S, Barton P, et al. Clinical and cost-effectiveness of epoprostenol, iloprost, bosentan, sitaxentan and sildenafil for pulmonary arterial hypertension within their licensed indications: a systematic review and economic evaluation. Health Technol Assess 2009 Oct; 13(49): 1–320
Acknowledgements
Research and writing support was provided to Analysis Group, Inc. by Bayer HealthCare Pharmaceuticals.
Dr Kirson, Dr Birnbaum, Ms Ivanova and Ms Waldman are employees of Analysis Group, Inc. Drs Joish and Williamson are employees of Bayer HealthCare Pharmaceuticals. The authors wish to thank Dr David Muccino for his assistance in reviewing the final manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kirson, N.Y., Birnbaum, H.G., Ivanova, J.I. et al. Excess costs associated with patients with pulmonary arterial hypertension in a US privately insured population. Appl Health Econ Health Policy 9, 293–303 (2011). https://doi.org/10.2165/11592430-000000000-00000
Published:
Issue Date:
DOI: https://doi.org/10.2165/11592430-000000000-00000