Healthcare resource utilization and costs for patients with pulmonary arterial hypertension: real-world documentation of functional class

Abstract

Background and aims: Pulmonary arterial hypertension (PAH) is a rare medical disease in which patients experience increased pulmonary vascular resistance (PVR) and pulmonary arterial pressure that can result in remodeling of the pulmonary vasculature and heart, and eventually lead to right heart failure and death. As PAH progresses, patients become unable to perform even routine daily tasks without severe shortness of breath (dyspnea), fatigue, dizziness, and fainting (syncope). Treatment strategies largely depend on assessment of an individual patient’s WHO Functional Class. The aim of the present study was to determine whether PAH functional decline, as described by the WHO Functional class (FC), is associated with increased healthcare costs for patients.

Methods: Patients with a prescription for a FDA-approved treatment for PAH and a medical claim indicating chronic pulmonary heart disease or right heart catheterization were identified from an administrative claims database. Provider-reported data from prior authorization forms required for advanced PAH therapies and medical charts were examined for reported FC. Healthcare resource utilization and costs were the primary outcomes of interest. Costs were accounted in 2014 US dollars ($) from a healthcare payer perspective.

Results: Patients with a reported FC-IV were observed to have the worst outcomes; averaging significantly more inpatient admissions, longer average lengths of stay, and more emergency department visits than the other FC sub-groups, resulting in higher medical costs.

Conclusions: Using administrative data to document disease severity, this study replicates and expands on findings obtained from the registry study; disease severity was associated with higher healthcare resource utilization and costs. Stakeholders’ implications for patient management are discussed.

Keywords:

• Pulmonary arterial hypertension
• functional class
• risk status
• resource utilization and costs
• right-heart disease
• treatment guidelines

Transparency

Declaration of funding

This study was sponsored by Actelion Pharmaceuticals, US. Data collection and analysis were conducted by Comprehensive Health Insights Inc., a Humana Company, Louisville, KY, USA, and funded by Actelion Pharmaceuticals Ltd.

Declaration of financial/other interests

R. Dufour, N. Hu, S. Stemkowski, and D. Lane are full-time employees of Comprehensive Health Insights. W. Drake III, J. Pruett, Y. Tsang, and C. Lickert are employees of Actelion US. Peer reviewers on this manuscript have received an honorarium from JME for their review work, but have no other relevant financial relationships to disclose.

Acknowledgments

The authors would like to thank Nick Patel and Amanda Caldwell-Tarr at Comprehensive Health Insights for their assistance in reviewing and editing this manuscript.

Previous presentations

Some of these results have been presented as a poster at the 18th annual ISPOR European Congress (Milan, IT; November 2015). The complete findings have not been published in any other venue.