Healthcare burden of pulmonary hypertension owing to lung disease and/or hypoxia

• Published in: BMC pulmonary medicine Vol. 17; no. 1; p. 58
• Main Authors: Heresi, Gustavo A, Platt, David M, Wang, Wenyi, Divers, Christine H, Joish, Vijay N, Teal, Simon A, Yu, Justin S
• Format: Journal Article
• Language: English
• Published: England BioMed Central 11.04.2017; BMC
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Care; Catheterization; Chronic obstructive pulmonary disease; Classification; Codes; Comorbidity; Costs; Databases, Factual; Demographics; Echocardiography; Female; Generalized linear models; Health Care Costs; Health care policy; Healthcare costs; Heart; Hospitalization - economics; Humans; Hypertension, Pulmonary - classification; Hypertension, Pulmonary - drug therapy; Hypertension, Pulmonary - epidemiology; Hypoxia; Hypoxia - complications; Insurance Claim Review; Lung diseases; Lung Diseases, Interstitial - complications; Male; Mathematical models; Medical prognosis; Middle Aged; Patients; Pharmacoeconomics; Pulmonary arterial hypertension; Pulmonary fibrosis; Pulmonary hypertension; Pulmonology; Regression Analysis; Resource utilization; Retrospective Studies; Review boards; Thromboembolism; United States; World Health Organization; Young Adult; United States > US; Hypoxia; Healthcare costs; Pulmonary arterial hypertension; Lung diseases; Pulmonary hypertension
• ISSN: 1471-2466; 1471-2466
• DOI: 10.1186/s12890-017-0399-1

Group 3 pulmonary hypertension (PH) encompasses PH owing to lung diseases and/or hypoxia. Treatment patterns, healthcare resource use, and economic burden to US payers of Group 3 PH patients were assessed. This retrospective observational study extracted data from July 1, 2010 to June 30, 2013 from two Truven Health Analytics MarketScan databases. Adult Group 3 PH patients were identified based on claims for PH (ICD-9-CM 416.0/416.8), a related lung disease, and an echocardiogram or right heart catheterization (RHC). The index date was the date of the first PH claim; data were collected for 12 months pre- and post-index. A difference-in-difference approach using generalized estimating equations was done to account for baseline differences. Group 3 PH patients (n = 2,236) were matched 1:1 to controls on lung disease. PH patients had higher all-cause resource utilization and annual healthcare costs ($44,732 vs. $7,051) than controls. Costs were driven by inpatient admissions (35.4% of total costs), prescriptions (33.0%), and outpatient care (26.5%). Respiratory-related costs accounted for 11.4% of post-index annual costs for PH patients. PH diagnosis was not confirmed in the majority of PH patients (<7% RHC use) but nevertheless, 22% of PH patients post-index had claims for drugs approved for the treatment of pulmonary arterial hypertension (PAH). Group 3 PH poses a significant clinical and economic burden. Given the low use of RHC and the prevalence of PAH-indicated prescriptions that are not currently approved for Group 3 PH, this study suggests some Group 3 PH patients may not be receiving guideline-recommended treatment.