A model for estimating the health economic impact of earlier diagnosis of chronic thromboembolic pulmonary hypertension

Boon, G.; Hout, Wilbert B. van den; Bogaard, Harm Jan; Delcroix, Marion; Huisman, Menno V.; Konstantinides, Stavros; Meijboom, Lilian J.; Nossent, Esther J.; Symersky, Petr; Vonk‐Noordegraaf, Anton; Klok, Frederikus A.

doi:10.1183/23120541.00719-2020

Cited by 17 publications

(21 citation statements)

References 53 publications

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“…The potentially life-threatening disease chronic thromboembolic pulmonary hypertension (CTEPH) is preceded by a diagnosis of acute pulmonary embolism (PE) in 75% [ 1 , 2 ]. Establishing a CTEPH diagnosis is known to be challenging as exemplified by a long diagnostic delay of up to 14 months, causing loss of quality-adjusted life years [ 3 ]. Moreover, the longest delays have been associated with worse pulmonary haemodynamics and excess mortality [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Prediction of chronic thromboembolic pulmonary hypertension with standardised evaluation of initial computed tomography pulmonary angiography performed for suspected acute pulmonary embolism

et al. 2021

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Objectives Closer reading of computed tomography pulmonary angiography (CTPA) scans of patients presenting with acute pulmonary embolism (PE) may identify those at high risk of developing chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to validate the predictive value of six radiological predictors that were previously proposed. Methods Three hundred forty-one patients with acute PE were prospectively followed for development of CTEPH in six European hospitals. Index CTPAs were analysed post hoc by expert chest radiologists blinded to the final diagnosis. The accuracy of the predictors using a predefined threshold for ‘high risk’ (≥ 3 predictors) and the expert overall judgment on the presence of CTEPH were assessed. Results CTEPH was confirmed in nine patients (2.6%) during 2-year follow-up. Any sign of chronic thrombi was already present in 74/341 patients (22%) on the index CTPA, which was associated with CTEPH (OR 7.8, 95%CI 1.9–32); 37 patients (11%) had ≥ 3 of 6 radiological predictors, of whom 4 (11%) were diagnosed with CTEPH (sensitivity 44%, 95%CI 14–79; specificity 90%, 95%CI 86–93). Expert judgment raised suspicion of CTEPH in 27 patients, which was confirmed in 8 (30%; sensitivity 89%, 95%CI 52–100; specificity 94%, 95%CI 91–97). Conclusions The presence of ≥ 3 of 6 predefined radiological predictors was highly specific for a future CTEPH diagnosis, comparable to overall expert judgment, while the latter was associated with higher sensitivity. Dedicated CTPA reading for signs of CTEPH may therefore help in early detection of CTEPH after PE, although in our cohort this strategy would not have detected all cases. Key Points • Three expert chest radiologists re-assessed CTPA scans performed at the moment of acute pulmonary embolism diagnosis and observed a high prevalence of chronic thrombi and signs of pulmonary hypertension. • On these index scans, the presence of ≥ 3 of 6 predefined radiological predictors was highly specific for a future diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), comparable to overall expert judgment. • Dedicated CTPA reading for signs of CTEPH may help in early detection of CTEPH after acute pulmonary embolism.

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Section: Introductionmentioning

confidence: 99%

Prediction of chronic thromboembolic pulmonary hypertension with standardised evaluation of initial computed tomography pulmonary angiography performed for suspected acute pulmonary embolism

et al. 2021

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“… 10 Besides impaired prognosis, each additional BPA session was estimated to increase annual hospital costs by 10,000 Euro and medication costs by 20,000 Euro. 6 Moreover, patients with blunted hemodynamic improvement after BPA are more likely to receive PH targeted medication, which might further exaggerate the financial cost to 25,000 Euro per quality-adjusted life year. 6 Due to limitation in daily activity and high financial cost, patients with CTEPH also suffered from profound emotional burdens and poor quality of life.…”

Section: Discussionmentioning

confidence: 99%

“… 6 Moreover, patients with blunted hemodynamic improvement after BPA are more likely to receive PH targeted medication, which might further exaggerate the financial cost to 25,000 Euro per quality-adjusted life year. 6 Due to limitation in daily activity and high financial cost, patients with CTEPH also suffered from profound emotional burdens and poor quality of life. 11 Increased BPA sessions and prolonged medical treatment could further increase patients’ anxiety.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of early response to balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension

Zhang

Jin

et al. 2022

Ther Adv Respir Dis

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Background: To achieve favorable hemodynamics, the number of balloon pulmonary angioplasty (BPA) sessions varied significantly among patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Increased BPA sessions burdened patients financially and psychologically. We aim to identify baseline characteristics that could predict early BPA response. Methods: Consecutive patients who were diagnosed with inoperable CTEPH and received BPA between May 2018 and October 2021 at Fuwai Hospital were retrospectively collected. Patients were categorized into ‘Early BPA responders’ or ‘Non-early BPA responders’ according to the hemodynamic outcome within the first three BPA sessions. Results: In total, 101 patients were included into analysis. At baseline, non-early BPA responders had lower female proportion, longer disease duration, and poorer laboratory test results compared with early responders, whereas hemodynamics were comparable. After the first three BPA sessions, hemodynamic improvement was more significant in early responders. Incidence of complication was comparable between the two groups. Multivariable logistic analysis identified that female sex (odds ratio [OR]: 7.155, 95% confidence interval [CI]: 1.323-38.692, p = 0.022), disease duration (OR: 0.851, 95% CI: 0.727-0.995, p = 0.043), baseline total bilirubin (OR: 0.934, 95% CI: 0.875-0.996, p = 0.038), and baseline NT-proBNP (OR: 0.473, 95% CI: 0.255-0.879, p = 0.018) were independently associated with early BPA response. Combination of these four parameters could predict 90% early BPA response. Conclusions: Patients with shorter disease duration, female sex, lower baseline NT-proBNP, and lower baseline total bilirubin are more likely to achieve early hemodynamic response to BPA. Moreover, early hemodynamic response was not accompanied with increased incidence of procedure-related complications.

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“…See Data S1 for the search string and the results of the systematic review of the literature. 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 …”

Section: Methodsmentioning

confidence: 99%

Cost‐of‐Illness Analysis of Long‐Term Health Care Resource Use and Disease Burden in Patients With Pulmonary Embolism: Insights From the PREFER in VTE Registry

Farmakis

Mavromanoli

Agnelli

et al. 2022

JAHA

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Background As mortality from pulmonary embolism (PE) decreases, the personal and societal costs among survivors are receiving increasing attention. Detailing this burden would support an efficient public health resource allocation. We aimed to provide estimates for the economic and disease burden of PE also accounting for long‐term health care use and both direct and indirect costs beyond the acute phase. Methods and Results This is a cost‐of‐illness analysis with a bottom‐up approach based on data from the PREFER in VTE registry (Prevention of Thromboembolic Events—European Registry in Venous Thromboembolism). We calculated direct (clinical events and anticoagulation) and indirect costs (loss of productivity) of an acute PE event and its 12‐month follow‐up in 2020 Euros. We estimated a disability weight for the 12‐month post‐PE status and corresponding disability adjusted life years presumably owing to PE. Disease‐specific costs in the first year of follow‐up after an incident PE case ranged between 9135 Euros and 10 620 Euros. The proportion of indirect costs was 42% to 49% of total costs. Costs were lowest in patients with ongoing cancer, mainly because productivity loss was less evident in this already burdened population. The calculated disability weight for survivors who were cancer free 12 months post‐PE was 0.017, and the estimated disability adjusted life years per incident case were 1.17. Conclusions The economic burden imposed by PE to society and affected patients is considerable, and productivity loss is its main driver. The disease burden from PE is remarkable and translates to the loss of roughly 1.2 years of healthy life per incident PE case.

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A model for estimating the health economic impact of earlier diagnosis of chronic thromboembolic pulmonary hypertension

Cited by 17 publications

References 53 publications

Prediction of chronic thromboembolic pulmonary hypertension with standardised evaluation of initial computed tomography pulmonary angiography performed for suspected acute pulmonary embolism

Prediction of chronic thromboembolic pulmonary hypertension with standardised evaluation of initial computed tomography pulmonary angiography performed for suspected acute pulmonary embolism

Predictors of early response to balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension

Cost‐of‐Illness Analysis of Long‐Term Health Care Resource Use and Disease Burden in Patients With Pulmonary Embolism: Insights From the PREFER in VTE Registry

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