High Costs, Hospitalizations Linked to PH, ILD

A retrospective cohort analysis that analyzed records for 122 patients with pulmonary hypertension due to interstitial lung disease (PH-ILD) over a 2-year period bisected by their first pulmonary hypertension (PH) diagnosis found that all-cause hospitalizations rose from 29.5% of patients pre-index to 59.0% of patients post index, according to a study in BMC Pulmonary Medicine.¹

Mean (SD) all-cause health care costs climbed to $108,387 ($190,673) post index compared with $43,201 ($98,604) pre-index (P < .0001), largely due to hospitalizations, the authors stated. They also saw approximate 150% increases in median health care costs of $20,732 to $50,843.

“This change was driven primarily by higher rates of inpatient care, more outpatient visits, and increased prescription drug use,” the authors stated.

Other measures also showed an increase over the 4-year period: intensive care unit (ICU) stays (6.6% vs 17.2%), mean inpatient visits (0.5 to 1.1), length of stay (5.4 vs 7.5 days), bed days (2.5 to 8), ICU days (3.8 vs 7), and outpatient visits (24.5 to 32.9).

Hospitalization costs increased from a mean of $13,133 ($28,752) to $63,218 ($142,142) over the period (P < .0001), and outpatient costs from $16,150 ($75,639) to $25,604 ($93,964) (P < .0001).

Hospitalizations among patients with comorbid pulmonary hypertension and interstitial lung disease more than doubled over a 2-year period in this analysis | Image Credit: meeboonstudio-stock.adobe.com

Most patients (99.2%) were recorded as making outpatient visits during the pre- and postindex periods. Slightly more than a third of patients visited the emergency department (ED) in both the pre- and postindex periods (37.7% vs 34.4%), and the majority of patients had a doctor visit during these periods (93.4% vs 94.3%). The mean for overall outpatient visits was significantly higher post index relative to preindex (32.9 vs 24.5).

Patients were indexed according to their first claim on a PH diagnosis. Researchers then compared data 12 months prior to index date with 12 months post index.

The mean age of patients, who were all adults, was 63.7 years; 64.8% were female; and 54.9% had commercial insurance. Patients’ most common comorbidities were chronic pulmonary disease (94.3%), diabetes (36.1%), and rheumatic disease (34.4%).

Patients largely stayed on the same medications pre- and post index: corticosteroids (43.4% vs 53.5%), calcium channel blockers (25.4% vs 36.9%), and oxygen (12.3% vs 25.4%). Data were taken from the Truven Health MarketScan Commercial Claims and Encounters Database and Medicare Supplemental Database. Patients with non-ILD, PH-associated conditions were excluded from the study.

To calculate total health care costs, the researchers included medical and prescription costs paid by both the health plan and patient (copayments, coinsurance, deductibles).

Roughly 5% of patients seeing a doctor for the first time due to pulmonary fibrosis may also suffer from PH, and some studies have shown that about 15% to 50% of patients with IPF may have associated PH, according to the Pulmonary Fibrosis Foundation.²

“Patients with ILD can develop PH over time. The presence of PH in patients with ILD can lead to worse survival compared to ILD alone, although more information is needed to better understand the impact of PH on ILD patient,” Benjamin Wu, PharmD, MS, coauthor of the study and a health economics and outcomes researcher at United Therapeutics Corporation, wrote in an email. “Our study showed that PH-ILD leads to major increases in hospitalizations and healthcare costs. Timely management and treatment of patients with PH-ILD is needed and could help mitigate the detrimental clinical and economic consequences.”

References

1. Heresi G, Dean B, Wu B, et al. Burden of illness in patients with pulmonary hypertension due to interstitial lung disease: a real-world analysis. BMC Pulm Med. 2024;24(1):335. doi:10.1186/s12890-024-03141-3

2. Pulmonary hypertension related to ILD (for patients). Pulmonary Fibrosis Foundation. Accessed July 17, 2024. https://www.pulmonaryfibrosis.org/researchers-healthcare-providers/clinical-resources/position-statements/pulmonary-hypertension-related-to-ild-for-patients