title: The economic burden of pulmonary arterial hypertension (PAH) in the US on payers and patients.
abstract: BACKGROUND
  Pulmonary arterial hypertension (PAH) is a rare condition that can ultimately lead to right heart failure and death. In this study we estimated the health care costs and resource utilization associated with PAH in a large US managed care health plan.
  
  
  METHODS
  Subjects with claims-based evidence of PAH from 1/1/2004 to 6/30/2010 (identification period) were selected. To be included in the final PAH study sample, subjects were required to have ≥2 claims with a primary PH diagnosis; ≥2 claims with a PAH related-diagnosis (connective tissue diseases, congenital heart diseases, portal hypertension); and ≥1 claim with evidence of a PAH-indicated medication. The earliest date of a claim with evidence of PAH-indicated medication during the identification period was set as the index date. Health care costs and resource utilization were compared between an annualized baseline period and a 12 month follow-up period.
  
  
  RESULTS
  504 PAH subjects were selected for the final study cohort. Estimated average total health care costs were approximately 16% lower in the follow-up period compared to the baseline period (follow-up costs = $98,243 [SD = 110,615] vs. baseline costs = $116,681 [SD = 368,094], p < 0.001), but substantively high in each period relative to costs reported for other chronic diseases. Pharmacy costs were significantly higher in the follow-up period vs. the baseline period, ($38,514 [SD = 34,817] vs. $6,440 [SD = 12,186], p < 0.001) but medical costs were significantly lower in the follow-up vs. baseline ($59,729 [SD = 106,683] vs. $110,241 [SD = 368,725], p < 0.001). These costs were mirrored in health-care resource utilization estimates. The average counts of ambulatory visits and inpatient stays were lower in the follow-up vs. the baseline (both p < 0.001). Results varied in exploratory analyses when less restrictive subject identification algorithms were used.
  
  
  CONCLUSIONS
  Subjects with evidence of PAH had substantively high health care costs. Medical costs appeared to decrease following PAH medication use, but with a concomitant increase in pharmacy costs.
authors.affiliation: Value Evidence and Outcomes, GlaxoSmithKline, 2301 Renaissance Blvd, King of Prussia, PA, 19406, USA. mirko.sikirica@bayer.com.
authors.forename: Mirko
authors.initials: M
authors.lastname: Sikirica
authors.affiliation: Health Economics and Outcomes Research, Optum, 12125 Technology Drive, Eden Prairie, MN, 55344, USA. Serban.Iorga@optum.com.
authors.forename: Serban R
authors.initials: SR
authors.lastname: Iorga
authors.affiliation: Health Economics and Outcomes Research, Optum, 12125 Technology Drive, Eden Prairie, MN, 55344, USA. Timothy.Bancroft@optum.com.
authors.forename: Tim
authors.initials: T
authors.lastname: Bancroft
authors.affiliation: Market Access and Value Strategy, Optum, 12125 Technology Drive, Eden Prairie, MN, 55344, USA. Jesse.Potash@optum.com.
authors.forename: Jesse
authors.initials: J
authors.lastname: Potash
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000191:economics; D006976:Hypertension, Pulmonary / Q000191:economics*; D007345:Insurance Claim Review / Q000191:economics; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008297:Male; D008875:Middle Aged; D014481:United States