Patients With PAH Accrue Higher Costs, HRU, Regardless of Etiology

Pulmonary arterial hypertension (PAH), regardless of the etiology, carries a significant economic burden, found a new study published in Pulmonary Circulation.

The study, which collected data from Optum's de-identified Clinformatics Data Mart Database, showed that patients with PAH related to connective tissue disorders (CTDs) and patients with PAH related to another condition accrued higher costs and higher health care resource use (HRU) compared with patients who had CTD without pulmonary hypertension.

“To date, several studies have reported that PAH is associated with a substantial burden in terms of HRU and costs in the United States, which may be exacerbated among patients with greater PAH severity,” wrote the researchers. “However, there is currently limited information specific to the burden of illness among patients with CTDs plus PAH in the real-world setting. Further, given the evolving landscape of treatment options and recommendations, contemporary data on the burden of CTDs and PAH are needed to better understand the burden of PAH overall from a clinical and health care payer perspective.”

The study included over 500,000 patients, of which 1800 had CTD-related PAH, 8000 had PAH of another etiology, and 200,000 had CTDs. The group also included 333,000 controls. All patients were followed for up to 12 months.

Patients with CTD-related PAH accrued significantly higher mean total all-cause costs than patients with PAH of another etiology ($16,854 vs $15,686 per patient per month [PPPM]; P = .02), which was attributable to differences in pharmacy costs. PAH-related costs were $11,682 PPPM among patients with CTD-related PAH and $10,287 PPPM among patients with PAH of another etiology. Pharmacy costs and inpatient costs accounted for approximately 75% of costs for both groups

Both of these groups had higher total all-cause costs than patients with CTD alone ($4476 PPPM; P < .001) and the controls ($2170 PPPM; P < .001).

Similar patterns were observed among HRU, with patients with CTD-related PAH and patients with PAH of anther etiology having similar average utilization PPPM for inpatient (0.15 vs 0.15, respectively) and outpatient (4.23 vs 4.11, respectively) visits. Utilization was lower for patients with CTDs and controls.

“Contemporary prescribing practices, such as the increased use of early combination therapy, may help to prevent further increases in the HRU burden among patients with CTDs and PAH despite higher pharmacy costs,” explained the researchers. “This treatment strategy is also supported by prior analyses of clinical trial data and evidence from retrospective claims-based studies.”

The researchers cited the single-arm, open-label OPTIMA study, which showed that initial treatment with a PDE5 inhibitor and an endothelin receptor antagonist yielded significant improvements in various outcomes. Data from a recent meta-analysis of randomized controlled trials and registries between 2000 and 2019 showed that modern PAH treatments have resulted in comparable risk reductions in morbidity and mortality for patients with CTD-related PAH and patients with PAH of any etiology.

Reference

Tsang Y, Panjabi S, Funtanilla V, et al. Economic burden of illness among patients with pulmonary arterial hypertension (PAH) associated with connective tissue disorders (CTD). Pulm Circ. Published online March 31, 2023. doi:10.1002/pul2.12218