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Pulmonary Vascular Disease |

What Costs Can a U.S. Health Plan Expect if an Enrollee Has Chronic Thromboembolic Pulmonary Hypertension? A Guideline-Based Estimate of Healthcare Resource Use and Cost

Vijay Joish, PhD; Christine Divers, PhD; Chakkarin CBurudpakdee, PharmD; Anshul Shah, MS; Stephen Mathai, MD
Author and Funding Information

Bayer HealthCare Pharmaceuticals, Wayne, NJ


Chest. 2014;145(3_MeetingAbstracts):523A. doi:10.1378/chest.1821901
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Abstract

SESSION TITLE: DVT/PE Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: To outline the resource use and costs a U.S. health plan can anticipate during the evaluation and first year of treatment of a CTEPH patient

METHODS: An interactive economic model was developed based on the 2009 diagnostic and treatment guidelines for pulmonary hypertension published by the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association. Model assumptions were as follows: a) patient and physician are 100% adherent to diagnostics and treatments; b) patient undergoes all diagnostic tests before diagnosis within a 12-month period; c) patient is assumed to have stable disease over the 12-month treatment period; d) off-label PAH drugs administered intravenously or subcutaneously were administered by a provider first and subsequently at home and e) guideline recommended disease management costs were included however cost of pharmacotherapy monitoring and adverse events were not included. The model estimates the resource and costs for three types of CTEPH patient: operable, inoperable, and residual PH. Unit costs were derived from publically available sources that included MediSpan’s master drug database, Medicare 2013 physician fee schedule, and Medicare clinical diagnostic laboratory fee schedule.

RESULTS: Diagnostic costs were $6,357.69 per patient. Surgery was a major cost in operable and residual PH ($60,433.70 per patient), while annual pharmacotherapy costs per patient were $115.44 for operable, $1,206.24 for inoperable and $38,805.60 for residual PH patients. Disease management costs per patient were highest for residual PH ($7,529.58) while costs were similar for operable and inoperable patients ($3,436.81).

CONCLUSIONS: This guideline-based model will assist health plans to better understand the resources and costs in the first year before and after diagnosis of CTEPH.

CLINICAL IMPLICATIONS: Actuarial models help health plans asses risk and estimate premiums for their members. However, models seldom provide insights on a single patient for rare conditions like chronic thromboembolic pulmonary hypertension (CTEPH). Although the current prevalence of CTEPH is not well defined, it is estimated to be between 3000-4000 patients in the United States.

DISCLOSURE: Vijay Joish: Employee: employee of bayer sponsor of study Christine Divers: Employee: employee of bayer sponsor of study Chakkarin CBurudpakdee: Consultant fee, speaker bureau, advisory committee, etc.: consultant of bayer sponsor of study Anshul Shah: Consultant fee, speaker bureau, advisory committee, etc.: consultant of bayer sponsor of study Stephen Mathai: Consultant fee, speaker bureau, advisory committee, etc.: consultant to bayer sponsor of study

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