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  • Title: The cost to managed care of managing pulmonary hypertension.
    Author: Said Q, Martin BC, Joish VN, Kreilick C, Mathai SC.
    Journal: J Med Econ; 2012; 15(3):500-8. PubMed ID: 22313330.
    Abstract:
    OBJECTIVE: To estimate direct medical costs and resource use for commercially-insured patients within two pulmonary hypertension sub-groups: pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). RESEARCH DESIGN AND METHODS: Using a retrospective cohort design, subjects (≥18 years) with ICD-9 code 416.0 (PAH or CTEPH) or 416.8 (CTEPH) were identified during 2004-2009 within the MarketScan database. The date of the first observed claim was the index date. Each PAH and CTEPH patient was matched to one-to-five controls without PAH and CTEPH on age, gender, region, and payer type. Patients and controls were continuously enrolled for at least 12 months pre- and 12 months post-index date. Per-patient-per-month costs and resource use were compared using Wilcoxon rank-sum test. RESULTS: PAH patients (1647) and controls (6352) were identified (mean age 63 years, 73% female). Total monthly costs before PAH diagnosis were: PAH patients $2064 vs controls $1094. After PAH diagnosis, PAH patients had significantly higher monthly costs and resource use vs controls: Total costs $4021 vs $1533, outpatient visits 1.1 vs 0.8, inpatient visits 0.7 vs 0.2, prescriptions 3.6 vs 2.7, all p-values <0.05. One hundred and forty-six CTEPH patients and 558 controls were identified (mean age 64 years, 54.8% female). Total monthly costs in the period before CTEPH diagnosis were higher for CTEPH patients ($3895) than controls ($1177). After CTEPH diagnosis, CTEPH patients had significantly higher monthly costs and resource use vs controls: Total costs $6198 vs $1579, Outpatient visits 1.2 vs 0.8, inpatient visits 2 vs 0.2, prescriptions 4.2 vs 2.8, all p-values <0.05. KEY LIMITATIONS: Identification of PAH is complicated, as there exists no precise ICD-9-CM code for the condition. CTEPH diagnosis was based upon claims data and was not verified clinically. CONCLUSIONS: CTEPH and PAH patients incurred higher costs and used more resources than controls in the baseline and follow-up periods.
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