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

Figures & data

Table 1. Baseline characteristics overall and by prevalence/incidence status.

Characteristic	Overall cohort (n = 157)	Prevalent PAH (n = 44)	Incident PAH (n = 113)	p-value
Mean age^a (SD)	65.4 (14.4)	61.0 (17.8)	67.1 (12.5)	0.085
Male (n, %)	37, 23.6%	6, 13.6%	31, 27.4%	0.067
Comorbidity^b (n, %)
Diabetes Mellitus	27, 17.2%	4, 9.1%	23, 20.4%	0.093
Hypertension	82, 52.3%	16, 36.4%	66, 58.4%	0.013
Heart Failure	31, 19.5%	9, 20.5%	22, 19.5%	0.889
Liver Disorder	4, 2.6%	1, 3.0%	3, 2.7%	0.891
Mean chronic disease score (SD)	5.8 (3.1)	5.8 (2.9)	5.7 (3.2)	0.900
Race (n, %)				0.181
White	110, 70.1%	27, 61.4%	83, 73.5%
Black/African American	12, 7.6%	2, 4.6%	10, 8.9%
Native American/Alaskan Indian	3, 1.8%	2, 4.6%	1, 0.9%
Asian/Pacific Islander	3, 1.8%	1, 2.3%	2, 1.8%
Undeclared	29, 18.5%	12, 27.3%	17, 15.0%
World Health Organization PAH Classification (n, %)				0.103
Class 1	86, 54.8%	31, 70.5%	55, 48.7%
Class 2	5, 3.2%	0, 0.0%	5, 4.4%
Class 3	53, 33.8%	10, 22.7%	43, 38.1%
Class 4	10, 6.4%	3, 6.8%	7, 6.2%
Class 5	3, 1.9%	0, 0.0%	3, 2.7%

^aAs of January 1, 2005 for prevalent patients and PAH diagnosis date for incident patients.

^bWithin the prior 180 days from January 1, 2005 for prevalent patients and within the prior 180 days from PAH diagnosis date for incident patients.

Figure 1. Cumulative deaths by incident/prevalent PAH case status.

Table 2. Study outcomes overall and by prevalent/incident status.

Outcome	Overall cohort (n = 157)	Prevalent PAH (n = 44)	Incident PAH (n = 113)	Unadjusted p-value	p-value adjusted^a
Mean days of follow-up (SD)	938 (305)	843 (377)	975 (265)	0.033	0.020
Six-minute walk (n, %)	19, 12.1%	6, 13.6%	13, 11.5%	0.713	0.650
Deceased during follow-up (n, %)	30, 28.0%	11, 25.0%	19, 16.8%	0.241	0.109
Median PPPD total spend (mean, IQR)	$56 ($140, $29–$166)	$54 ($161, $30–$202)	$56 ($132, $29–$166)	0.284	0.950
Median PPPD pharmacy spend^a (mean, IQR)	$5 ($38, $2–$14)	$4 ($44, $2–$15)	$5 ($35, $2–$12)	0.867	0.346
Median PPPD inpatient spend (mean, IQR)	$8 ($27, $1–$24)	$1 ($27, $1–$17)	$8 ($28, $1–$27)	0.130	0.183
Median PPPD medical office spend (mean, IQR)	$8 ($19, $8–$20)	$13 ($16, $9–$19)	$12 ($20, $8–$21)	0.941	0.157
Median PPPD emergency dept. spend (mean, IQR)	$1 ($3, $1–$3)	<$1 ($2, <$1–$1)	$1 ($4, $1–$4)	0.052	0.874
Median PPPD other spend (mean, IQR)	$16 ($53, $8–$64)	$14 ($73, $8–$74)	$17 ($45, $8–$59)	0.975	0.724
Median PPPD specialty medications spend^b (mean, IQR)	$226 ($211, $175–$271)	$226 ($230, $203–$291)	$223 ($201, $175–$263)	0.574	0.994
Median PPPD non-specialty medications spend (mean, IQR)	$5 ($14, $2–$11)	$4 ($13, $2–$11)	$5 ($14, $2–$11)	0.821	0.668
Median total spend (mean, IQR)	$50,559 ($125,733, $25,958–$135,535)	$37,340 ($138,900, $20,442–$116,515)	$55,073 ($120,606, $27,426–$141,619)	0.284	0.111
Median total pharmacy spend^b (mean, IQR)	$4,480 ($40,186, $1682–$12478)	$3,733 ($47,049, $1,290–$16,101)	$4,700 ($37,513, $1,762–$12,382)	0.625	0.842
Median total inpatient spend (mean, IQR)	$6,952 ($20,259, $0–$20,200)	$980 ($21,409, $0–$14,099)	$7,313 ($19,811, $0–$26,480)	0.028	0.824
Median total medical office spend (mean, IQR)	$12,260 ($16,151, $6,614–$19,160)	$10,543 ($12,899, $5,688–$17,810)	$12,689 ($17,417, $6,792–$19,920)	0.362	0.513
Median total emergency dept. spend (mean, IQR)	$820 ($2,562, $0–$3,152)	$357 ($911, $0–$1,380)	$1,250 ($3,206, $0–$4,250)	0.009	0.502
Median total other spend (mean, IQR)	$14,854 ($46,548, $7,821–$38,608)	$11,081 ($56,599, $5,022–$39,430)	$15,466 ($42,635, $8,060–$38,608)	0.214	0.117
Median total specialty medications spend^c (mean, IQR)	$247,269 ($230,594, $191,611–$296,653)	$247,269 ($251,410, $222,804–$318,707)	$244,356 ($220,186, $191,188–$287,920)	0.574	0.861
Median total non-specialty medications spend (mean, IQR)	$4,370 ($13,748, $1,681–$10,419)	$3,133 ($12,765, $1,289–$9,493)	$4,584 ($14,130, $1,761–$11,029)	0.373	0.205

^aAdjusted for age, sex, race, Chronic Disease Score, and histories of diagnosis for hypertension and diabetes mellitus. Spend data were log transformed in adjusted analysis.

^bIncludes specialty medications.

^cIncludes only patients with at least one purchase of a specialty medication (n = 18).

IQR, Interquartile range; PAH, Pulmonary arterial hypertension; PPPD, Per patient per day; SD, Standard deviation.

Table 3. Patient characteristics by World Health Organization (WHO) PAH class status.

Characteristic	Class 1 (n = 86)	Class 2 (n = 5)	Class 3 (n = 53)	Class 4 (n = 10)	Class 5 (n = 3)	p-value
Mean age (SD)	61.8 (16.0)	77.8 (9.4)	68.8 (11.2)	71.2 (9.1)	66.7 (1.5)	0.008
Male (n, %)	17, 19.8%	1, 20.0%	15, 28.3%	2, 20.0%	5, 66.7%	0.325
Comorbidity (n, %)
Diabetes Mellitus	14, 16.3%	1, 20.0%	11, 20.8%	1, 10.0%	0, 0.0%	0.882
Hypertension	41, 47.7%	3, 60.0%	31, 58.5%	5, 50.0%	2, 66.7%	0.744
Heart Failure	18, 20.9%	2, 40.0%	10, 18.9%	0, 0.0%	1, 33.3%	0.280
Liver Disorder	3, 3.5%	0, 0.0%	1, 1.9%	0, 0.0%	0, 0.0%	0.929
Mean chronic disease score (SD)	5.4 (3.3)	5.8 (1.4)	6.2 (3.1)	5.2 (2.2)	7.7 (2.3)	0.548
Race (n, %)						0.441
White	57, 66.3%	4, 80.0%	39, 73.6%	8, 80.0%	2, 66.7%
Black/African
American	8, 9.3%	1, 20.0%	2, 3.8%	1, 10.0%	0, 0.0%
Native American/Alaskan Indian	1, 1.2%	0, 0.0%	2, 3.8%	0, 0.0%	0, 0.0%
Asian/Pacific Islander	2, 2.3%	0, 0.0%	0, 0.0%	1, 10.0%	0, 0.0%
Undeclared	18, 20.9%	0, 0.0%	10, 18.9%	0, 0.0%	1, 33.3%
Incident PAH (n, %)	55, 64.0%	5, 100%	43, 81.1%	7, 70.0%	3, 100%	0.103

Table 4. Study outcomes by World Health Organization (WHO) PAH class status.

Outcome	Class 1 (n = 86)	Class 2 (n = 5)	Class 3 (n = 53)	Class 4 (n = 10)	Class 5 (n = 3)	p-value
Mean days of follow-up (SD)	929 (315)	1066 (65)	923 (322)	987 (228)	1095 (0)	0.715
Six-minute walk (n, %)	13, 15.2%	0, 0.0%	2, 3.8%	3, 30.0%	1, 33.3%	0.034
Deceased during follow-up (n, %)	15, 17.4%	1, 20.0%	12, 22.6%	2, 20.0%	0, 0.0%	0.928
Median total PPPD spend (mean, IQR)	$58 ($169, $30–$266)	$25 ($56, $24–$41)	$53 ($95, $28–$85)	$97 ($176, $49–$124)	$115 ($121, $59–$188)	0.138
Median pharmacy PPPD spend^a (mean, IQR)	$5 ($49, $2-$26)	$5 ($5, $2–$7)	$4 ($17, $2–$10)	$8 ($77, $4–$14)	<$1 ($5, <$1–$16)	0.115
Median inpatient PPPD spend (mean, IQR)	$3 ($28, <$1–20)	$1 ($10, <$1–$8)	$12 ($28, <$1–$27)	$13 ($19, $7–$28)	$55 ($55, $36–$73)	0.895
Median medical office PPPD spend (mean, IQR)	$13 ($18, $1–$21)	$12 ($27, $9–$14)	$11 ($21, $7–$18)	$14 ($14, $9–$18)	$14 ($11, <$1–$20)	0.804
Median emergency dept. PPPD spend (mean, IQR)	$1 ($3, <$1–$3)	$1 ($3, <$1–$4)	$1 ($4, <$1–$4)	$1 ($2, <$1–$3)	$1 ($2, <$1–$4)	0.804
Median other PPPD spend (mean, IQR)	$16 ($71, $8–$79)	$8 ($12, $7–$17)	$15 ($25, $8–$28)	$36 ($65, $12–$67)	$24 ($47, $7–$111)	0.408
Median specialty medications PPPD spend^b (mean, IQR)	$229 ($220, $203–$255)	N/A	$178 ($172, $175–$181)	$274 ($192, $11–$291)	N/A	0.498
Median non-specialty medications PPPD spend (mean, IQR)	$5 ($16, $2–$14)	$5 ($5, $2–$7)	$4 ($10, $2–$10)	$6 ($19, $3–$11)	<$1 ($5, <$1–$16)	0.743
Median total spend (mean, IQR)	$49,115 ($153,516, $22,603–$216,707)	$27,429 ($60,336, $25,036–$45,007)	$42,271 ($75,886, $26,920–84,300)	$63,120 ($181,807, $47,709–$135,535)	$125,766 ($132,016, $64,598–$205,685)	0.114
Median total pharmacy spend^a (mean, IQR)	$4,429 ($52,882, $1,414–$28,451)	$5,524 ($5,436, $2,290–$7,300)	$4,075 ($16,568, $1,872–$9,518)	$7,419 ($83,818, $4,257–$15,572)	$265 ($5,947, $2–$17,570)	0.103
Median total inpatient spend (mean, IQR)	$2,849 ($20,124, $0–$16,440)	$639 ($10,663, $304–$7,241)	$10,016 ($19,865, $0–$29,200)	$11,849 ($16,446, $7,251–$27,640)	$59,806 ($59,770, $39,000–$80,000)	0.738
Median total medical office spend (mean, IQR)	$12,907 ($15,935, $6,614–$20,511)	$12,854 ($29,034, $9,491–$15,510)	$10,583 ($15,987, $6,039–$18,590)	$14,837 ($13,546, $9,890–$18,300)	$15,711 ($1,2427, $0–$22,000)	0.639
Median total emergency dept. spend (mean, IQR)	$523 ($2,334, $0–$2,391)	$820 ($2,685, $348–$3,910)	$1,380 ($3,163, $0–$4,410)	$904 ($1,477, $0–$2,790)	$1,417 ($1,890, $0–$4,300)	0.766
Median total other spend (mean, IQR)	$15,084 ($62,203, $6,866–$77,410)	$8,247 ($12,517, $8,060–$18,600)	$12,330 ($20,297, $7,997–$23,115)	$27,659 ($66,438, $11,100–$73,100)	$26,815 ($51,982, $77,320–$121,400)	0.430
Median total specialty medications spend^b (mean, IQR)	$250,974 ($240,754, $222,805–$279,187)	N/A	$194,998 ($194,988, $191,611–$198,385)	$299,744 ($210,296, $12,435–$318,707)	N/A	0.498
Median total non-specialty medications spend (mean, IQR)	$4,314 ($16,488, $1,413–$14,874)	$5,523 ($5,435, $2,286–$7,294)	$4,074 ($9,209, $1,871–$9,481)	$5,526 ($20,729, $3,137–$12,381)	$264 ($5,946, $0–$17,570)	0.728

^aIncludes specialty medications.

^bIncludes only patients with at least one purchase of a specialty medication (n = 18).

IQR, Interquartile range; PAH, Pulmonary arterial hypertension; PPPD, Per patient per day; SD, Standard deviation.