PURPOSE: As the economic burden of pulmonary arterial hypertension (PAH) is unknown, estimate excess direct costs for privately-insured PAH patients in the US.
METHODS: From a privately-insured claims database (>8 million beneficiaries, 2002-2007), 471 PAH patients were identified having: ≥2 claims for primary pulmonary hypertension (PH), ICD-9-CM: 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); ≥1 claim for right heart catheterization (RHC) within 6 months prior to any PH claim or ≥1 claim for echocardiogram within 6 months prior to a specialist-diagnosed PH claim; ages 18-64. Patients with PAH were matched demographically to controls without PH. Patients were followed as long as continuously eligible; mean follow-up was 24.8 months. Chi-squared tests were used to compare baseline comorbidities. Wilcoxon rank-sum tests were used to compare direct (medical and pharmaceutical) patient-month costs to insurers.
RESULTS: 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 comorbidities (e.g., essential hypertension, diabetes, and CHF) and higher Charlson Comorbidity Index. Mean (median) direct patient-month costs in 2007 dollars were $2,023 ($675) for PAH patients and $498 ($104) for controls (p< 0.0001), yielding excess costs of $1,525 ($571). Sensitivity analysis restricting the sample to patients diagnosed following RHC yields a 64% increase in excess costs. Regarding cost drivers, inpatient services accounted for 45%, outpatient for 38%, and drugs for 15% of PAH direct patient-month costs. Circulatory/respiratory system-related patient-month costs were $724 ($194) among PAH patients and $114 ($9) among controls (p< 0.0001).
CONCLUSION: Patients with PAH had substantially higher costs than controls, with circulatory/respiratory system-related costs accounting for 40% of excess costs.
CLINICAL IMPLICATIONS: The high burden of illness suggests opportunity for savings from improved management.
DISCLOSURE: Vijay Joish, Other Research and writing support was provided to Analysis Group, Inc. by Bayer HealthCare Pharmaceuticals, Inc. Noam Kirson is an employee of Analysis Group, Inc. Howard Birnbaum is an employee of Analysis Group, Inc. Jasmina Ivanova is an employee of Analysis Group, Inc. Tracy Waldman is an employee of Analysis Group, Inc. Matt Schiller is an employee of Analysis Group, Inc. Vijay Joish is an employee of Bayer HealthCare Pharmaceuticals, Inc. Todd Williamson is an employee of Bayer HealthCare Pharmaceuticals, Inc.; No Product/Research Disclosure Information