PAH Patients’ Heathcare Costs Are Similar Before and After Treatment Starts, Study Shows

Ashraf Malhas, PhD avatar

by Ashraf Malhas, PhD |

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The healthcare costs of Americans with pulmonary arterial hypertension (PAH) are about the same before and after treatment starts, mainly because high treatment costs offset fewer hospitalizations, a study shows.

The research, “Treatment Patterns and Associated Health Care Costs Before and After Treatment Initiation Among Pulmonary Arterial Hypertension Patients in the United States,” was published in the Journal of Managed Care and Specialty Pharmacy.

PAH treatment is expensive due to medication and hospitalization costs. But only a limited number of studies have assessed the relationship between PAH therapy and overall healthcare costs.

So researchers conducted a retrospective study in real-world settings to investigate the use and costs of healthcare resources before and after PAH-specific treatment was given to patients.

Data on 3,908 PAH patients in the Truven Health MarketScan Commercial and Medicare Supplemental Databases were analyzed, between 2010 and 2014. The mean age of the patients was 63 years. All initiated treatment with endothelin receptor antagonists (ERAs), phosphodiesterase-5 inhibitors (PDE-5Is), or soluble guanylate cyclase (sGC) stimulators.

The study assessed treatment patterns and healthcare utilization and costs. Treatment patterns were examined for the first six months of treatment initiation, while healthcare was examined for the six months before and after treatment initiation.

Nearly all patients (95 percent) received monotherapy (a single therapeutic agent), while 5 percent followed a combination therapy regimen.

Results showed that overall inpatient admissions significantly decreased in the six months following treatment initiation, compared with the six-month period preceding it (30 vs 42 percent). Of those, PAH-related admissions decreased from 7 to 3 percent.

Comparing the two periods, non-pharmacy medical costs were found to significantly decrease from $48,200 to $33,962, but total average medical costs, which included pharmacy costs, were not significantly different ($51,455 vs $53,923).

The results indicated that “while patients’ PAH-related pharmacy costs increased after treatment initiation, the increase was offset by reduced inpatient utilization; therefore, total healthcare costs remained constant,” the team wrote.

It is important to note that, up to 2015, initial treatment after diagnosis involved the use of a single PAH-specific medication. The AMBITION Phase 3 clinical trial (NCT01178073), however, demonstrated that a combination therapy approach offers more benefits compared to a monotherapy approach.

The study was performed prior to the AMBITION study, and hence, most patients had a mono rather than combination therapy.

“While the majority of patients in this study were treated with monotherapy, the recently completed AMBITION study indicated that initial combination therapy with ambrisentan plus tadalafil reduced PAH-related hospitalizations compared with initial monotherapy with either of these agents. Future cost analyses of patients treated with combination therapy will be required to determine the economic effect of initial combination therapy,” the researchers wrote.