Economic burden of illness among patients with pulmonary arterial hypertension (PAH) associated with connective tissue disorders (CTD)

Abstract

Pulmonary arterial hypertension (PAH) is commonly associated with connective tissue disorders (CTDs). This study provides a contemporary assessment of the economic burden of CTD + PAH and PAH in the United States. Eligible adult patients identified from Optum's deidentified Clinformatics® Data Mart Database (10/01/2015‐09/30/2021) were classified into mutually exclusive cohorts based on recorded diagnoses: (1) CTD + PAH, (2) PAH, (3) CTD, (4) control without CTD/PAH. The index date was a randomly selected diagnosis date for PAH (CTD + PAH, PAH cohorts) or CTD (CTD cohort), or a random date (control cohort). Entropy balancing was used to balance characteristics across cohorts. Healthcare costs and healthcare resource utilization (HRU) per patient per month (PPPM) were assessed for ≤12 months postindex and compared among balanced cohorts. A total of 552,900 patients were included (CTD + PAH: n = 1876; PAH: n = 8177; CTD: n = 209,156; control: n = 333,691). Average total all‐cause costs were higher for CTD + PAH than PAH cohort ($16,854 vs. $15,686 PPPM; p = 0.02); both cohorts incurred higher costs than CTD and control cohorts ($4476 and $2170 PPPM; all p < 0.001). Average HRU PPPM was similar between CTD + PAH and PAH cohorts (inpatient stay: 0.15 vs. 0.15, outpatient visits: 4.23 vs. 4.11; all p > 0.05), while CTD and control cohorts incurred less HRU (inpatient stay: 0.07 and 0.03, outpatient visits: 2.67 and 1.69; all p < 0.001). CTD + PAH and PAH are associated with a substantial economic burden. The incremental burden attributable to PAH versus the general population and patients with CTD without PAH highlights significant unmet needs among PAH patients.

Impact of the COVID‐19 pandemic on care disruptions, outcomes, and costs in patients receiving pulmonary arterial hypertension‐specific therapy in the United States of America: An observational study

“…The geographic variation in insurance coverage and its overrepresentation in the South may have introduced bias. The Optum CDM database has known overrepresentation in the Southern US region 19 . States in the South had less stringent enforcement of lockdown measures (e.g., fewer stay‐at‐home orders), and this may have dampened the impact of COVID‐19 that we observed on PAH‐related tests, including RHCs.…”

“…The Optum CDM database has known overrepresentation in the Southern US region. 19 States in the South had less stringent enforcement of lockdown measures (e.g., fewer stay‐at‐home orders), and this may have dampened the impact of COVID‐19 that we observed on PAH‐related tests, including RHCs. Our analyses were based on assumptions about the comparability of the immediate post‐ and pre‐COVID‐19 groups.…”

Real-World Treatment Patterns Among Patients with Connective Tissue Disorder-Related Pulmonary Arterial Hypertension in the United States: A Retrospective Claims-Based Analysis

“…Optum’s CDM database is geographically diverse and represents all 50 states (as well as the District of Columbia and Puerto Rico). It includes adjudicated health insurance claims for commercial and Medicare Advantage enrollees within a large national managed care company affiliated with Optum, as previously described [ 30 ]. Using the Expert Determination method and in accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the CDM database was statistically de-identified and managed according to Optum’s customer data use agreements; therefore, no review by an institutional review board was required per Title 45 of CFR, Part 46.101(b)(4) ( https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/#46.101 ).…”