Study Reveals Stark Differences Between Medicare Advantage, Commercially Insured PAH Patients’ Healthcare Costs

Patrícia Silva, PhD avatar

by Patrícia Silva, PhD |

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shutterstock_201717266According to a recent study published online in the American Journal of Managed Care, PH-related hospitalizations lead to high healthcare costs, with patients with PAH requiring long hospital stays. The study results also revealed that many patients with PAH are readmitted within 1 year of receiving their diagnosis. Based on the findings, researchers indicate the need for improved treatment methods to diminish the progression of PAH in order to reduce costs and burdens related with inpatient stays.

In the study entitled “Characterizing Pulmonary Hypertension–Related Hospitalization Costs Among Medicare Advantage or Commercially Insured Patients With Pulmonary Arterial Hypertension: A Retrospective Database Study,” James Burke and colleagues analyzed the claims between 2007 and 2011 of 4,009 US patients with PAH in order to assess pulmonary hypertension (PH)-related hospitalizations and readmissions.

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Patients were selected if they had commercial or Medicare Advantage coverage, and if they met the criteria for ≥1 medical claim with a PH-related diagnostic code (ICD Diseases code 416.0 primary pulmonary hypertension or 416.8 for other chronic pulmonary heart disease) and ≥1 pharmacy claim for a PAH drug prescription.

Results revealed that of the total 4,009 patients that met the study criteria, 2,275 had ≥1 PH-related follow-up hospitalizations: from these 56.9% were female, 59.4% were aged above 65, and 67.8% had commercial insurance coverage. The average costs associated with hospitalizations were $46,118 for PAH patients covered with commercial insurance and $16,319 for PAH patients covered with Medicare Advantage; the length of stay in the hospital was 10.9 days for PAH patients under commercial insurance and 12.8 days for patients under Medicare Advantage coverage.

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Compared to patients with other diagnoses, healthcare costs and length of stay were greater for patients admitted with a PH principal diagnosis $42,455 versus $61,922 and 10.2 versus 14.2 days for patients with commercial insurance, and of $19,584 versus $15,904 and 16.7 vs. 12.3 days, respectively, for patients with Medicare Advantage coverage. Results also showed that from the 954 PAH patients who were readmitted in the first year after they were discharged from the initial hospitalization, 50.6%, 25.8%, and 23.6% had respectively 1, 2, and ≥3 hospital readmissions.

Based on these results, the researchers suggest that improved treatment methods are necessary to reduce PAH progression and boost reduction of costs and hospital stays.