Early CTEPH Diagnosis Linked to Key Benefits, ‘Acceptable’ Costs

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by Steve Bryson PhD |

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Using a healthcare cost model, researchers in the Netherlands found that an early diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) leads to substantial life expectancy and quality of life benefits at an “acceptable” price.

Although greater healthcare costs were associated with an earlier diagnosis — primarily due to the costs of medications — “according to Dutch health economic standards, additional costs remain below the deemed acceptable limit,” the researchers wrote.

According to the team, these findings back efforts by healthcare providers to achieve earlier diagnoses in people with this rare form of pulmonary hypertension — which could help prevent “premature deaths from undiagnosed patients,” they wrote.

“This model can be used for evaluating cost-effectiveness of diagnostic strategies aimed at reducing the diagnostic delay,” the team wrote.

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The study, “A model for estimating the health economic impact of earlier diagnosis of chronic thromboembolic pulmonary hypertension,” was published in the journal ERJ Open Research.

CTEPH is characterized by abnormally high blood pressure or hypertension in the arteries of the lungs, caused by the formation of blood clots (embolisms).

Diagnosis is often delayed due to the difficulty of detecting and confirming CTEPH in routine physical exams — the disease’s symptoms can develop over a long period of time and mimic those of other heart and lung conditions.

Such delays lead to higher artery pressures in the lungs at diagnosis and lower survival rates. Despite this, strategies to diagnose CTEPH early are usually not included in routine care following blood clot formation.

Studies examining the health outcomes and economic costs of early CTEPH diagnosis are currently lacking.

“Such knowledge is urgently needed to guide policy makers to decide on optimal and cost-effective follow-up after acute pulmonary embolism,” the researchers wrote.

Now, a team based at Leiden University Medical Center, in the Netherlands, and their collaborators, constructed a model to estimate lifelong outcomes based on the time of CTEPH diagnostic delay.

The model included three types of CTEPH treatments and a no-treatment group. The treatments were pulmonary endarterectomy surgery to remove arterial blockages, balloon pulmonary angioplasty — a minimally invasive procedure to open blood vessels — and PH-targeted therapy. For each group, life expectancy, quality of life, and healthcare costs were estimated.

Survival and quality of life data were collected from published studies, and costs were measured from 498 patient records at a Dutch CTEPH center. Medication costs were based on standard treatment regimens.

To reflect current care, the model assessed a “typical CTEPH patient.” In 50% of cases, this patient is male, with a fixed age of 63 at diagnosis, and a fixed diagnostic delay of 1.2 years.

The analysis found the life expectancy of these patients would be 14.3 years with 8.42 quality-adjusted life-years, known as QALY. This metric is used to determine the value of medical interventions, and includes both the quality and the quantity of life lived. Specifically, one QALY equals one year of perfect health.

Based on a hypothetical situation of no delay between the first symptoms and a CTEPH diagnosis, the estimated extension of life expectancy was 3.01 years. There also was an increase of 2.04 QALYs, of which 0.28 was due to improved quality of life during a delay and the remaining 1.76 due to improved life expectancy.

An estimated two-year survival after the first appearance of symptoms would rise from 74% for the current delay of 1.2 years to 88% without delay, “suggesting that premature deaths from undiagnosed patients can be prevented,” the team wrote.

For the typical CTEPH patient with a mix of treatment options, the total lifelong healthcare costs were estimated at €117,105 (about $136,000). Reducing the diagnostic delay from 1.2 to 0 years would increase the cost to €161,759 (about $188,000).

The increase of €44,654 (about $52,000) represented an increase in the use of healthcare, of which 87%, or €38,675 (about $45,000), was due to the costs of medications.

In a plausible situation in which diagnosis was delayed to half of a year, the estimated life expectancy would increase by 1.08 years with a 0.76 increase in QALYs. This would increase healthcare costs per QALY gained by €27,199 (about $31,500).

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Further analyses confirmed that overall costs were most affected by medication costs rather than hospital costs. A 50% increase in medication costs would lead to an additional cost of €30,400 (about $35,000) per QALY.

If more patients treated with balloon pulmonary angioplasty were given medications, this would lead to an increase of €25,000 (about $29) per QALY. An equal number of balloon pulmonary angioplasty and pulmonary endarterectomy treatments would result in an even greater increase in medication use.

Younger age at diagnosis would increase life expectancy and lower costs by €18,400 (about $21,000) per QALY. Also, a more positive impact of treatment would lower spending. If the price of screening programs were established at €20,000 (about $23,000) to reduce diagnostic delay, this would increase overall costs by €29,700 (about $34,500) per QALY.

“In conclusion, this cost-effectiveness analysis based on a Dutch healthcare perspective is the first major effort to start focusing on quantitative assessment of the economic burden of reducing the diagnostic delay of CTEPH versus the benefits for healthcare systems and, thus, for society as a whole,” the scientists wrote.

“Our results indicate beneficial lifelong patient-relevant outcomes against acceptable additional costs after accomplishing an earlier CTEPH diagnosis,” the team concluded.