title: Treatment patterns and healthcare system burden of managed care patients with suspected pulmonary arterial hypertension in the United States.
abstract: OBJECTIVE
  To describe treatment patterns and healthcare burden among individuals with suspected pulmonary arterial hypertension (PAH), as identified through a practice guideline-based healthcare claims algorithm.
  
  
  METHODS
  Adults with evidence of PAH from 1 January 2004 (commercial and Medicaid) or 1 July 2006 (Medicare Advantage) through 30 June 2008 were identified. Given the lack of an ICD-9 code for PAH, an algorithm was developed requiring: (1) ≥ 1 claim for PAH medication (index date); (2) ≥ 1 claim with a pulmonary hypertension diagnosis code in the 6-month pre-index period (baseline) or within 90 days post-index; (3) a right heart catheterization or pulmonary hypertension-related inpatient stay during baseline or within 90 days post-index; and (4) continuous health plan enrollment for 6 months pre-index and ≥ 6 months post-index. Patients with PAH-specific medications during baseline were excluded. Treatment patterns, healthcare utilization, and costs were assessed during the period ending with the earlier of health plan disenrollment or 31 December 2008.
  
  
  RESULTS
  Among the 521 included patients, 69% were female. Most patients (94%) initiated treatment with monotherapy (most commonly sildenafil or bosentan), and 12.7% of all patients augmented their therapy by the end of the observation period. The medication possession ratio was 0.96 each for ambrisentan (SD=0.04), bosentan (SD=0.04), and sildenafil (SD=0.05). Overall, 72.6% of patients discontinued therapy with a mean of 149 (SD=170) days until discontinuation. A mean (SD) of 2.14 (1.82) all-cause office and 1.64 (1.98) outpatient visits occurred per patient per month. Mean PAH-related healthcare costs were $6617 per patient per month, comprising 71% of all-cause costs. The guideline-based algorithm may not have perfectly captured patients with PAH.
  
  
  CONCLUSIONS
  Patients with suspected PAH were likely to initiate treatment with oral monotherapy, had high compliance rates, and received close ambulatory follow-up. PAH-related costs constituted the majority of all-cause healthcare costs.
authors.affiliation: OptumInsight, Eden Prairie, MN 55344, USA.
authors.forename: Ronda
authors.initials: R
authors.lastname: Copher
authors.forename: Annamaria
authors.initials: A
authors.lastname: Cerulli
authors.forename: Angela
authors.initials: A
authors.lastname: Watkins
authors.forename: Maria
authors.initials: M
authors.lastname: Laura Monsalvo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003266:Continuity of Patient Care; D003695:Delivery of Health Care / Q000191:economics*; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000191:economics; D007345:Insurance Claim Review; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D014481:United States; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents