PURPOSE: As the economic burden of chronic thromboembolic pulmonary hypertension (CTEPH) is unknown, estimate excess direct costs for privately-insured CTEPH patients in the US.
METHODS: From a privately-insured claims database (>8 million beneficiaries, 2002-2007), 289 CTEPH patients were identified having: ≥2 claims for pulmonary hypertension (PH), ICD-9-CM: 416.0, 416.8; ≥1 claim for pulmonary embolism (ICD-9-CM: 415.1, V12.51; ICD-9 procedure: 38.7; CPT-4: 36010, 37620, 75825, 75940; HCPCS: C1880) 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 CTEPH were matched demographically to controls without PH. Patients were followed as long as continuously eligible; mean follow-up was 21.5 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 CTEPH patients was 52.2 years, and 57.1% were women. Compared with controls, CTEPH patients had significantly higher baseline rates of comorbidities (e.g., essential hypertension, congestive heart failure, and chronic pulmonary disease) and a higher Charlson Comorbidity Index. Mean (median) direct patient-month costs were $4,782 ($1,503) for CTEPH patients and $511 ($95) for controls (p< 0.0001). Sensitivity analysis restricting the sample to patients diagnosed following RHC yields a 15% increase in excess costs. Regarding cost drivers, inpatient services accounted for 54%, outpatient services for 33%, and drug for 11% of CTEPH patient-month direct costs. Circulatory/respiratory-related patient-month costs were $2,496 ($622) among CTEPH patients and $128 ($7) among controls (p< 0.0001).
CONCLUSION: CTEPH patients had substantially higher costs than matched controls, with circulatory/respiratory-related costs accounting for 55% of excess costs.
CLINICAL IMPLICATIONS: The high burden suggests an opportunity for savings from optimizing and improving 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