title: Treatment patterns and resource utilization and costs among patients with pulmonary arterial hypertension in the United States.
abstract: OBJECTIVE
  To explore treatment patterns and resource utilization and cost for subjects with pulmonary arterial hypertension (PAH).
  
  
  METHODS
  Retrospective claims database analysis of 706 patients with PAH enrolled in a large, geographically diverse US managed-care organization.
  
  
  RESULTS
  In the final sample of PAH patients treated with bosentan (n=251) or sildenafil (n=455), average age was 57 years, 86% of patients were commercially insured, and 52% of patients were male. Gender distribution varied significantly across subgroups, with a lower proportion of males in the bosentan (30%) subgroup compared with the sildenafil group (64%) (p<0.001). Average baseline Charlson comorbidity score was 2.4. Average numbers of fills per month were 0.8 and 0.4 for bosentan and sildenafil patients, respectively (p<0.001). Over 80% of patients received only one PAH treatment in the first 90 days following the index date, with 28% of bosentan and 13% of sildenafil patients receiving combination therapy (p<0.001). Over one-third of bosentan patients and one-quarter of sildenafil patients experienced a dose increase in the follow-up period (p=0.009). Sixteen percent of sildenafil patients experienced a dose decrease in the follow-up period, while a smaller proportion of patients receiving bosentan (4%) experienced a dose decrease (p<0.001). On average, number of PAH-related per subject per month (PSPM) inpatient stays and emergency department visits and PSPM length of inpatient stays were statistically similar between the subgroups. PAH-related PSPM healthcare costs were high for both subgroups, with average monthly costs of $5,332 and $3,632 among bosentan and sildenafil patients, respectively (p=0.003). Differences in total costs were driven mainly by differences in pharmacy expenditures.
  
  
  CONCLUSIONS
  Of the oral agents approved for treating PAH at the time of this study, sildenafil was most commonly prescribed as index therapy and was also associated with the lowest costs, largely due to significantly lower pharmacy costs. This study is characterized by limitations inherent to claims database analyses, such as the potential for coding errors and lack of information on whether a drug was taken as prescribed. Furthermore, PAH severity (WHO functional class) was not assessed.
authors.affiliation: Lilly Research Laboratories, Eli Lilly & Co, Indianapolis, Indiana, USA. hydmallik02@hotmail.com
authors.forename: Mallik
authors.initials: M
authors.lastname: Angalakuditi
authors.forename: Eric
authors.initials: E
authors.lastname: Edgell
authors.forename: Anthony
authors.initials: A
authors.lastname: Beardsworth
authors.forename: Erin
authors.initials: E
authors.lastname: Buysman
authors.forename: Tim
authors.initials: T
authors.lastname: Bancroft
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000191:economics; D000077300:Bosentan; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000191:economics*; D007345:Insurance Claim Review; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage / Q000191:economics; D011687:Purines / Q000008:administration & dosage / Q000191:economics; D012189:Retrospective Studies; D000068677:Sildenafil Citrate; D013449:Sulfonamides / Q000008:administration & dosage / Q000191:economics; D013450:Sulfones / Q000008:administration & dosage / Q000191:economics; D014481:United States; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D010879:Piperazines; D011687:Purines; D013449:Sulfonamides; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate; D000077300:Bosentan