The cost to managed care of managing pulmonary hypertension

Figures & data

Table 1.  Baseline demographic characteristics of study sample for PAH patients and matched controls.*.

	PAH (n = 1647)	Controls (n = 6352)	p-value*
Age, years, mean	62.57 (15.84)	63.65 (15.39)	0.1
Age group, n (%)
18–30 years	51 (3%)	147 (2%)	0.1
31–45 years	177 (11%)	625 (10%)
46–65 years	711 (43%)	2649 (42%)
66–85 years	612 (37%)	2540 (40%)
86 years or older	96 (6%)	391 (6%)
Female, n (%)	1203 (73%)	4642 (73%)	0.98
Region, n (%)
North East	169 (10%)	683 (11%)	0.62
North Central	510 (31%)	1989 (31%)
South	673 (41%)	2476 (39%)
West	288 (17%)	1182 (19%)
Unknown	7 (<1%)	22 (<1%)
Plan type, n (%)
Comprehensive	575 (35%)	2188 (34%)	0.98
HMO	237 (14%)	966 (15%)
POS	125 (8%)	480 (8%)
PPO	629 (38%)	2426 (38%)
Others	81 (5%)	292 (5%)
Comorbid conditions, n (%)
Heart Failure	229 (14%)	243 (4%)	<0.001
Cardiac dysrhythmias	161 (10%)	293 (5%)	<0.001
Symptoms involving respiratory system and other chest symptoms	146 (9%)	295 (5%)	<0.001
Diabetes mellitus	115 (7%)	280 (4%)	<0.001
Charlson Comorbid Index Score at baseline 1 year period, mean (SD)	2.55 (2.40)	1.56 (2.17)	<0.001

*Based on Chi-square test for categorical variables and Wilcoxon rank-sum test for continuous variables.

HMO, health maintenance organization; POS, point of service; PPO, preferred provider organization.

Table 2.  Mean per-patient-per-month costs and resource use for PAH patients and matched controls.*.

Economic outcomes	PAH (n = 1647)		Controls (n = 6352)		p-value**
	Pre-index period	Follow-up period	Pre-index period	Follow-up period
Utilization (n)
Inpatient visits	0.17	0.70	0.10	0.19	<0.001
Outpatient visits	0.81	1.13	0.73	0.82	<0.001
ER visits	0.14	0.24	0.11	0.15	<0.001
Number of Prescriptions	3.00	3.64	2.52	2.72	<0.001
Costs ($)
Total cost	$2064	$4021	$1094	$1533	<0.001
Inpatient cost	$713	$1741	$298	$519	<0.001
Outpatient cost	$961	$1632	$561	$758	<0.001
ER cost	$28	$55	$18	$29	0.012
Prescription cost	$390	$648	$226	$256	<0.001

*Costs are reported in 2009 US dollars.

**Based on Wilcoxon rank-sum test for estimating the significance in difference-in-difference.

Table 3.  Treatment and diagnostic characteristics of PAH patients vs matched controls.

	Baseline period		Follow-up period
	PAH (n = 1647)	Controls (n = 6352)	PAH (n = 1647)	Controls (n = 6352)
Pharmacotherapy
Oral anti-coagulants	340 (20.6%)	519 (8.2%)	419 (25.4%)	572 (9.0%)
Diuretics	785 (47.7%)	1709 (26.9%)	817 (49.6%)	1712 (27.0%)
Calcium channel blockers	488 (29.6%)	1261 (19.9%)	489 (29.7%)	1274 (20.1%)
Digoxin	188 (11.4%)	245 (3.9%)	186 (11.3%)	244 (3.8%)
Endothelin receptor antagonists (ERAs)	84 (5.1%)	0 (0.0%)	138 (8.4%)	1 (0.0%)
Prostacyclin analogues	26 (1.6%)	0 (0.0%)	55 (3.3)	0
Phosphodiesterase (PDE-5) inhibitors	74 (4.5%)	159 (2.5%)	175 (10.6%)	154 (2.4%)
Other therapeutic treatments
Vena cava procedure	5 (0.3%)	2 (0.0%)	10 (0.6%)	5 (0.1%)
stress echocardigraphy	7 (0.4%)	30 (0.5%)	2 (0.1%)	22 (0.3%)
Ventilation perfusion	0	0	1 (0.1%)	0 (0.0%)
Pulmonary endarterectomy	1 (0.1%)	0 (0.0%)	0	0
Oxygen therapy	0 (0.0%)	3 (0.0%)	3 (0.2%)	8 (0.1%)
Diagnostic procedures
Echocardiography	268 (16.3%)	303 (4.8%)	396 (24.0%)	259 (4.1%)
Other radiography	3 (0.2%)	17 (0.3%)	2 (0.1%)	14 (0.2%)
Electrocardiography	638 (38.7%)	1440 (22.7%)	619 (37.6%)	1389 (21.9%)
Computerized tomography (CT)	150 (9.1%)	457 (7.2%)	183 (11.1%)	494 (7.8%)
Angiography	6 (0.4%)	30 (0.5%)	18 (1.1%)	20 (0.3%)
Right heart catheterization	6 (0.4%)	0 (0.0%)	24 (1.5%)	2 (0.0%)
Other exercise testing	92 (5.6%)	223 (3.5%)	100 (6.1%)	159 (2.5%)
Magnetic resonance imaging (MRI)	0 (0.0%)	4 (0.1%)	1 (0.1%)	6 (0.1%)

Table 4.  Baseline demographic characteristics of study sample for CTEPH patients and matched controls.*.

	CTEPH (n = 146)	Controls (n = 558)	p-value*
Age, years, mean	63.8	64.3	0.709
Age group, n (%)			0.9904
18–30 years	2 (1%)	8 (1%)
31–45 years	11 (8%)	39 (7%)
46–65 years	72 (49%)	266 (48%)
66–85 years	53 (36%)	210 (38%)
86 years or older	8 (6%)	35 (6%)
Females, %	81 (55.5%)	305 (54.7%)	0.859
US region, n (%)			0.965
North east	12 (8%)	50 (9%)
North central	61 (42%)	241 (43%)
South	54 (37%)	193 (35%)
West	19 (13%)	74 (13%)
Plan type, n (%)
Comprehensive	57 (39%)	210 (38%)	0.921
HMO	13 (9%)	62 (11%)
POS	8 (5%)	31 (6%)
PPO	60 (41%)	226 (40%)
Others	8 (5%)	29 (5%)
Comorbid conditions, n (%)
Acute pulmonary heart disease	58 (40%)	3 (0.6%)	<0.001
Heart failure	20 (14%)	22 (4%)	<0.001
Symptoms involving respiratory syst/chest	20 (14%)	33 (6%)	0.002
Other lung diseases	19 (13%)	9 (2%)	<0.001
Pneumonia organism nos	17 (12%)	0 (0%)	<0.001
Charlson Comorbid Index (CCI) Score for the baseline 1 year period	4.02	1.73	<0.001

*Based on Chi-square test for categorical variables and Wilcoxon rank-sum test for continuous variables.

HMO, health maintenance organization; POS, point of service; PPO, preferred provider organization.

Table 5.  Mean per-patient-per-month costs and resource use for CTEPH patients and matched controls.*.

Economic outcomes	CTEPH		Controls		p-value**
	Pre-index period	Follow-up period	Pre-index period	Follow-up period
Utilization
Inpatient visits	0.56	1.97	0.10	0.17	<0.001
Outpatient visits	0.93	1.17	0.76	0.83	0.0375
ER visits	0.25	0.44	0.09	0.12	0.4559
Number of prescriptions	3.40	4.18	2.64	2.82	0.0035
Costs
Total cost	$3895	$6198	$1177	$1579	<0.001
Inpatient cost	$2347	$3382	$258	$507	<0.001
Outpatient cost	$1186	$2193	$658	$780	<0.001
ER cost	$46	$89	$20	$30	0.9111
Prescription cost	$362	$623	$260	$292	0.0337

*Costs are reported in 2009 US dollars.

**Based on Wilcoxon rank-sum test for estimating the significance in difference-in-difference.

Table 6.  Treatment and diagnostic characteristics of CTEPH patients vs matched controls.

	Baseline period		Follow-up period
	CTEPH (n = 146)	Controls (n = 558)	CTEPH (n = 146)	Controls (n = 558)
Prescription medication use
At least one prescription, n (%)
Oral anti-coagulants	66 (45.2%)	61 (10.9%)	83 (56.8%)	65 (11.6%)
Diuretics	75 (51.4%)	147 (26.3%)	68 (46.6%)	163 (29.2%)
Calcium channel blockers	36 (24.7%)	107 (19.2%)	31 (21.2%)	102 (18.3%)
Digoxin	9 (6.2%)	23 (4.1%)	13 (8.9%)	19 (3.4%)
Endothelin receptor antagonists (ERAs)	2 (1.4%)	0 (0.0%)	5 (3.4%)	0 (0.0%)
Diagnostic procedures
At least one procedure, n (%)
Echocardiography	28 (19.2%)	35 (6.3%)	33 (22.6%)	27 (4.8%)
Other radiography	0 (0.0%)	1 (0.2%)	0 (0.0%)	1 (0.2%)
Electrocardiography	66 (45.2%)	134 (24.0%)	63 (43.2%)	139 (24.9%)
Computerized tomography (CT)	36 (24.7%)	43 (7.7%)	25 (17.1%)	42 (7.5%)
Angiography	1 (0.7%)	7 (1.3%)	2 (1.4%)	5 (0.9%)
Other exercise testing	11 (7.5%)	22 (3.9%)	4 (2.7%)	19 (3.4%)
Stress echocardigraphy	2 (1.4%)	2 (0.4%)	0 (0.0%)	1 (0.2%)
Therapeutic procedures
At least one procedure, n (%)
Vena cava procedure	49 (33.6%)	0 (0.0%)	37 (25.3%)	0 (0.0%)
Pulmonary endarterectomy	0	0	1 (0.7%)	0 (0.0%)