Treatment patterns and healthcare system burden of managed care patients with suspected pulmonary arterial hypertension in the United States

Abstract

Objectives:

To describe treatment patterns and healthcare burden among individuals with suspected pulmonary arterial hypertension (PAH), as identified through a practice guideline-based healthcare claims algorithm.

Methods:

Adults with evidence of PAH from 1 January 2004 (commercial and Medicaid) or 1 July 2006 (Medicare Advantage) through 30 June 2008 were identified. Given the lack of an ICD-9 code for PAH, an algorithm was developed requiring: (1) ≥1 claim for PAH medication (index date); (2) ≥1 claim with a pulmonary hypertension diagnosis code in the 6-month pre-index period (baseline) or within 90 days post-index; (3) a right heart catheterization or pulmonary hypertension-related inpatient stay during baseline or within 90 days post-index; and (4) continuous health plan enrollment for 6 months pre-index and ≥6 months post-index. Patients with PAH-specific medications during baseline were excluded. Treatment patterns, healthcare utilization, and costs were assessed during the period ending with the earlier of health plan disenrollment or 31 December 2008.

Results:

Among the 521 included patients, 69% were female. Most patients (94%) initiated treatment with monotherapy (most commonly sildenafil or bosentan), and 12.7% of all patients augmented their therapy by the end of the observation period. The medication possession ratio was 0.96 each for ambrisentan (SD = 0.04), bosentan (SD = 0.04), and sildenafil (SD = 0.05). Overall, 72.6% of patients discontinued therapy with a mean of 149 (SD = 170) days until discontinuation. A mean (SD) of 2.14 (1.82) all-cause office and 1.64 (1.98) outpatient visits occurred per patient per month. Mean PAH-related healthcare costs were $6617 per patient per month, comprising 71% of all-cause costs. The guideline-based algorithm may not have perfectly captured patients with PAH.

Conclusions:

Patients with suspected PAH were likely to initiate treatment with oral monotherapy, had high compliance rates, and received close ambulatory follow-up. PAH-related costs constituted the majority of all-cause healthcare costs.

Key words::

• Claims analysis
• Health expenditures
• Pulmonary hypertension

Transparency

Declaration of funding

This study and manuscript preparation were funded by Novartis Pharma, Basel, Switzerland.

Declaration of financial/other relationships

RC and AW were both employees of OptumInsight (formerly Innovus) while the study was conducted. OptumInsight was contracted by Novartis to conduct the study. AC is an employee of Novartis. MLM was Medical Director at PharmaNet/i3 (formerly i3) while the study was conducted, and does not have any financial relationships to disclose.

Acknowledgments

The authors thank Jim Hartje (OptumInsight) for data analysis and programming, Laura Becker (OptumInsight) for assistance with data analysis, Adam Lowy (Novartis) for assistance with the study design, Elizabeth J. Davis, PhD (OptumInsight) for medical writing assistance, and RG McAllister, MD (Executive Director of Medical Affairs at PharmaNet/i3) and Rachel Halpern, PhD (OptumInsight) for thoughtful review of the manuscript.