title: Demographics, clinical characteristics, health resource utilization and cost of chronic thromboembolic pulmonary hypertension patients: retrospective results from six European countries.
abstract: BACKGROUND
  Chronic Thromboembolic Pulmonary Hypertension (CTEPH) results from incomplete resolution of a pulmonary embolus, leading to pulmonary hypertension and progressive right heart failure and death. We aimed to describe the demographics, treatment patterns, health resource utilization and related costs of patients with CTEPH.
  
  
  METHODS
  In specialized PH centres across six European countries, medical charts of CTEPH patients on PH medication were retrospectively extracted (chart review between 2006 and 2009). Resource utilization was valued using country-specific unit costs. Descriptive statistical analyses were performed.
  
  
  RESULTS
  Twenty-one hospitals documented 119 consecutive CTEPH patients over an average of 25.4 months. Patients were inoperable (83.9%) or persistent after surgery (16.0%) with mean age 67.5 ± 12.3 years, 61% were female. The average 6-minute walking distance was 298 ± 120 meters, and NYHA class II/III/IV was 27/59/14%. At baseline, 59.7% patients received endothelin receptor antagonist, 34.4% phosphodiesterase-5 inhibitors, and 5.8% prostacyclin. Adding a second PH medication was the most common regimen change. CTEPH patients experienced 1.8 ± 2.2 hospitalizations per year accounting for 14.8 ± 26.1 days in hospital. Patients paid on average 2.8 office visits per year to their general practitioner and 1.3 visits to a specialist. Unadjusted annual mortality rate was 6.0%. Annual cost of PH specific medication was the predominant economic factor averaging € 36,768 per year. Costs for hospitalizations (€ 4,496) and concomitant medications (€ 2,510) were substantially lower. Other health care resource items only accounted for marginal additional costs.
  
  
  CONCLUSIONS
  CTEPH patients are characterised by substantial morbidity and mortality. Health care utilisation, predominantly due to off-label use of PH drugs, is significant.
authors.affiliation: OptumInsight, Konrad-Zuse-Platz 11, D- 81829 Munich, Germany. bernd.schweikert@optum.com.
authors.forename: Bernd
authors.initials: B
authors.lastname: Schweikert
authors.forename: David
authors.initials: D
authors.lastname: Pittrow
authors.forename: Carmine Dario
authors.initials: CD
authors.lastname: Vizza
authors.forename: Joanna
authors.initials: J
authors.lastname: Pepke-Zaba
authors.forename: Marius M
authors.initials: MM
authors.lastname: Hoeper
authors.forename: Anja
authors.initials: A
authors.lastname: Gabriel
authors.forename: Jenny
authors.initials: J
authors.lastname: Berg
authors.forename: Mirko
authors.initials: M
authors.lastname: Sikirica
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003365:Costs and Cost Analysis; D005060:Europe; D017079:Exercise Tolerance; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data*; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000191:economics* / Q000503:physiopathology; D008485:Medical Audit; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000191:economics*; D012189:Retrospective Studies; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents