PAH Treatment Patterns and Costs Related to Hospitalization

Pulmonary arterial hypertension (PAH) is associated with significant morbidity and mortality, including hospitalization. New research presented at AMCP 2021, the annual meeting of the Academy of Managed Care Pharmacy, held virtually April 12-16, evaluated treatment patterns and costs related to hospitalization.

The first abstract reviewed PAH treatment patterns pre- and post hospitalization, as well as treatment modification during the hospital discharge period.¹ Although hospitalization is a major morbidity event for patients with PAH, as well as a predictor of survival, there are limited data on therapy management after a hospitalization, the authors explained.

They used Optum’s deidentified Clinformatics Data Mart Database from January 1, 2014, to June 30, 2019, to identify adult patients with PAH. Then they examined treatment patterns in the 30 days prior to and the 90 days after a hospitalization.

In total, 3116 patients with PAH had a hospitalization event. The majority (68%) were female, the mean age was 68 years, the mean Charlson comorbidity index score was 5.1, and the average length of hospitalization was 7 days.

Nearly two-thirds (64.8%) of patients were on monotherapy before their hospitalization compared with just 17.4% on double therapy and 3.1% on triple therapy. In addition, 456 (14.6%) patients had no evidence of PAH therapy prior to their hospitalization.

After the hospitalization, 73.8% had no change in their treatment and 84.6% of the patients who were not on PAH therapy before their hospitalization stayed off treatment after. Patients on monotherapy and double therapy were equally likely to stay on the same type of therapy (72.0% and 72.5%, respectively). Patients on triple therapy were a little less likely to stay with the same type of therapy (69.4%).

“PAH guidelines and risk algorithms other than REVEAL 2.0 do not often include hospitalization as a risk factor for worsening PAH,” the authors concluded. “Further research is required to understand how the new 2019 PAH treatment guideline would impact PAH management in the real-world setting.”

In the second abstract, researchers estimated hospitalization-related cost differences associated with treatment by selexipag (SEL) or oral treprostinil (OT).²

They created a comparative cost model to estimate the drug and hospitalization costs (total costs) to a US payer. Then they estimated for a 2-year horizon, which takes into account medication titration followed by maintenance dosing. They used real-world data from the Optum Clinformatics Data Mart Database along with the 2010 US Census and literature to define the population and hospitalization rates for patients (SEL: 0.632l; OT: 1.037).

In a hypothetical plan with 78 patients who have PAH, use of SEL would cost $43,281,212 and use of OT would cost $55,399,134 over 2 years. The SEL patients would have 98 related hospital admissions and the OT patients would have 161 admissions. SEL reduced costs by 21.87% over 2 years, saving $12 million over OT.

For a 1-year time horizon, SEL would save less as there would be less time for patients to receive their full dose strength, but it would still lead to savings of 4.3%.

“SEL is the preferred oral [prostacyclin pathway agent] option since benefits (hospitalization rate) of SEL outweigh those of OT and total costs (1- and 2-year) are lower than OT,” the researchers concluded.

References

1. Ogbomo A, Tsang Y, Kariburyo F, et al. Real-world analysis of treatment patterns among hospitalized pulmonary arterial hypertension patients. Presented at: AMCP 2021; April 12-16, 2021. Abstract I3.

2. Bilir S, Dufour R, Pruett J, Tsang Y, Panjabi S. Hospitalization-related costs associated with oral agents targeting the prostacyclin pathway for pulmonary arterial hypertension. Presented at: AMCP 2021; April 12-16, 2021. Abstract J8.