Characterizing the financial burden of pulmonary arterial hypertension within an integrated healthcare delivery system

Abstract

Purpose:

Financial burden associated with providing healthcare to patients with pulmonary arterial hypertension (PAH) is poorly characterized. This study sought to quantify 3-year healthcare expenditures and determine whether expenditures differed between incident and prevalent PAH cases.

Methods:

This was a retrospective cohort study of Kaiser Permanente Colorado (KPCO) patients with confirmed diagnosis of PAH. Included patients were followed from study entry until 3 years, death, or termination of KPCO membership, whichever came first. All expenditures were reported in 2011 US dollars from the KPCO perspective.

Results:

In total, 157 patients were included: 44 (28%) prevalent and 113 (72%) incident cases. Mean age (prevalent vs incident cases) was 61 years vs 67 years and 13.6% vs 27.4% were males. The majority of patients (55%) were classified as WHO Group 1 PAH. Prevalent cases had less follow-up (843 vs 975 days; p = 0.033). Overall, median total per patient per day (PPPD) and 3-year total expenditures were $56 (interquartile range (IQR = $29–$166) and $50,599 (IQR = $25,958–$135,535), respectively. After adjustment for patient characteristics and chronic disease burden, median PPPD ($54 vs $56; p = 0.950) and 3-year ($37,340 vs $55,073; p = 0.111) total expenditures were equivalent between prevalent and incident cases; however, the risk of death during the 3-year follow-up was lower among incident cases (hazard ratio = 0.41, 95% CI = 0.18–0.91). No significant differences were detected in pharmacy, inpatient, medical office, emergency department, or other expenditures. Median PAH specialty medication PPPD expenditures were also equivalent, also ($226 vs $223 among specialty medication users; p = 0.861).

Conclusion:

Healthcare expenditures related to PAH represent substantial financial burden. Significant differences according to prevalent or incident case status appeared to be driven by median ED and inpatient expenditures; however, PAH specialty medication expenditures represented a substantial cost-driver overall. Future efforts should focus on optimizing care for patients with PAH to avoid unnecessary harm or waste.

Key words::

• Pulmonary arterial hypertension
• Healthcare services
• Cost of illness

Transparency

Declaration of funding

The authors received no funding in preparation of this manuscript.

Declaration of financial/other relationships

SJ is a recipient of a $25,000 IOM Anniversary Fellowship Grant (2012–2014) and a $5000 ASHP Research and Education Foundation Residents Research Grant (2013–2014). Neither of these supported this work. CZ is an employee and has received sponsorship from Eli Lilly. TD, AB, and PS declare no conflicts of interest. CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.