title: Healthcare burden of pulmonary hypertension owing to lung disease and/or hypoxia.
abstract: Group 3 pulmonary hypertension (PH) encompasses PH owing to lung diseases and/or hypoxia. Treatment patterns, healthcare resource use, and economic burden to US payers of Group 3 PH patients were assessed.
  
  
  
  This retrospective observational study extracted data from July 1, 2010 to June 30, 2013 from two Truven Health Analytics MarketScan databases. Adult Group 3 PH patients were identified based on claims for PH (ICD-9-CM 416.0/416.8), a related lung disease, and an echocardiogram or right heart catheterization (RHC). The index date was the date of the first PH claim; data were collected for 12 months pre- and post-index. A difference-in-difference approach using generalized estimating equations was done to account for baseline differences.
  
  
  
  Group 3 PH patients (n = 2,236) were matched 1:1 to controls on lung disease. PH patients had higher all-cause resource utilization and annual healthcare costs ($44,732 vs. $7,051) than controls. Costs were driven by inpatient admissions (35.4% of total costs), prescriptions (33.0%), and outpatient care (26.5%). Respiratory-related costs accounted for 11.4% of post-index annual costs for PH patients. PH diagnosis was not confirmed in the majority of PH patients (<7% RHC use) but nevertheless, 22% of PH patients post-index had claims for drugs approved for the treatment of pulmonary arterial hypertension (PAH).
  
  
  
  Group 3 PH poses a significant clinical and economic burden. Given the low use of RHC and the prevalence of PAH-indicated prescriptions that are not currently approved for Group 3 PH, this study suggests some Group 3 PH patients may not be receiving guideline-recommended treatment.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA. heresig@ccf.org.
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Heresi
authors.affiliation: Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA.
authors.forename: David M
authors.identifier: 0000-0002-4625-0721
authors.initials: DM
authors.lastname: Platt
authors.affiliation: Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA.
authors.forename: Wenyi
authors.initials: W
authors.lastname: Wang
authors.affiliation: Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA.
authors.forename: Christine H
authors.initials: CH
authors.lastname: Divers
authors.affiliation: Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA.|Currently at Regeneron, Tarrytown, NY, USA.
authors.forename: Vijay N
authors.initials: VN
authors.lastname: Joish
authors.affiliation: Bayer Pharma AG, Berlin, Germany.
authors.forename: Simon A
authors.initials: SA
authors.lastname: Teal
authors.affiliation: Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA.|Currently at Allergan, Irvine, CA, USA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000145:classification* / Q000188:drug therapy / Q000453:epidemiology*; D000860:Hypoxia / Q000150:complications; D007345:Insurance Claim Review; D017563:Lung Diseases, Interstitial / Q000150:complications; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D014481:United States; D014944:World Health Organization; D055815:Young Adult
keywords: Healthcare costs; Hypoxia; Lung diseases; Pulmonary arterial hypertension; Pulmonary hypertension