Treatment Patterns and Associated Health Care Costs Before and After Treatment Initiation Among Pulmonary Arterial Hypertension Patients in the United States

Burger, Charles D.; Ozbay, A. Burak; Lazarus, Howard M.; Riehle, Ellen; Montejano, Leslie; Lenhart, Gregory; White, Robert J.

doi:10.18553/jmcp.2018.17391

Cited by 38 publications

(87 citation statements)

References 20 publications

(44 reference statements)

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“…The percentage of patients with upfront combination therapy increased from 5.7% in 2012-2013 to 13.0% following the publication of updated ESC/ERS guidelines. These percentages are much lower than the 45% on combination therapy in the REVEAL registry [26] and similar to proportions receiving combination therapy in previous claims studies, which ranged from 5% to 20% [27][28][29][30]. Patients in the REVEAL registry were not newly diagnosed or new initiators of treatment (more than half of patients were functional class III or IV and were referred to PAH specialty centers), which likely explains the high percentage of patients on combination therapy.…”

Section: Discussionsupporting

confidence: 63%

Retrospective Database Analysis of Treatment Patterns Among Patients with Pulmonary Arterial Hypertension

et al. 2019

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Introduction: Release of the 2015 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines put increased emphasis on using combination therapy, either as upfront or sequential therapy among patients with pulmonary arterial hypertension (PAH). However, with these recommendations and the therapy advances made in the last several years, little is known on the real-world treatment patterns among patients with PAH, particularly before and after publication of the 2015 ESC/ERS guidelines. Methods: This was a retrospective study of adult commercial and Medicare Advantage with Part D (MAPD) enrollees with at least one claim for a PAH-related medication from January 01, 2012 to March 31, 2017, at least one medical claim with a pulmonary hypertension diagnosis, and continuous health plan enrollment at least 6 months prior to and at least 12 months following the date of the first pharmacy claim for PAH-related therapy (index date). Patients were divided into cohorts based on prescription of monotherapy or combination therapy and index date category (

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Section: Discussionsupporting

confidence: 63%

Retrospective Database Analysis of Treatment Patterns Among Patients with Pulmonary Arterial Hypertension

et al. 2019

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“…These real-world data also suggest that medication adherence and persistence with oral prostacyclin therapies were similar in the cohorts. MPR to oral prostacyclin was high in both the oral treprostinil (89%) and selexipag (85%) cohorts, similar to that reported by Burger et al (89%) for prostacyclin use [18]. However, PDC from this study (72 and 71% for oral treprostinil and selexipag, respectively) were lower than those reported by Studer et al [17] when prostacyclin therapies were initiated as part of combination therapy (90%), but the estimates from this study were higher than when prostacyclin therapies were initiated as monotherapy (50%).…”

Section: Discussionsupporting

confidence: 85%

“…The binding of prostacyclin to platelets and endothelial cells results in the inhibition of platelet aggregation, relaxation of smooth muscle, and pulmonary artery dilation, which mediates the vasoconstriction associated with PAH and improves cardiac output [16]. Prostacyclin-class therapies are most often used in combination therapy in either first-or secondline regimens in patients with advanced FC [1,17] and are prescribed to about one-quarter of patients [17][18][19]. More recently, there has been a shift from parenteral to nonparenteral prostacyclin use [19].…”

Section: Study Outcomesmentioning

confidence: 99%

Medication Adherence and Healthcare Costs Among Patients with Pulmonary Arterial Hypertension Treated with Oral Prostacyclins: A Retrospective Cohort Study

Dean

Saundankar

Stafkey-Mailey

et al. 2020

Drugs - Real World Outcomes

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Background Given the improved convenience of oral prostacyclins, there is a shift toward their use in treating pulmonary arterial hypertension (PAH). Objectives Our objective was to compare patient characteristics, medication adherence, healthcare resource use (HCRU), and costs among patients receiving oral treprostinil or selexipag. Methods We used Truven Health MarketScan Commercial and Medicare databases to identify patients with PAH with a diagnosis code for pulmonary hypertension (PH) plus a prescription for oral treprostinil or selexipag from July 2013 to September 2017. Medication adherence, persistence, and all-cause and PAH-related HCRU and costs were compared between cohorts during the 6-month follow-up. Adjusted healthcare costs were obtained using recycled predictions and bootstrapped samples. Results A total of 256 (130 oral treprostinil, 126 selexipag) patients fulfilled the study criteria. The oral treprostinil cohort was more likely to be male, to have previously used parenteral prostacyclins, and to have higher outpatient costs at baseline than the selexipag cohort. During follow-up, both cohorts had similar proportions of patients who were adherent to and persistent with their respective therapies. All-cause and PAH-related medical utilization was generally similar between cohorts. The oral treprostinil cohort had 66.9% lower total PAH-related healthcare costs (mean difference − $75,183; 95% confidence interval [CI] − 102,584 to − 49,771) and 70.6% lower PAH-related pharmacy costs (mean difference − $76,439; 95% CI − 104,512 to − 51,458) than the selexipag cohort, with similar differences in all-cause healthcare and pharmacy costs. Conclusions Lower all-cause and PAH-related total healthcare and pharmacy costs were observed in patients receiving oral treprostinil compared with those receiving selexipag. It will be important to study longer-term costs and clinical outcomes.

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“…The cost savings obtained from decreasing nonpharmacy health costs such as hospital admissions were made up for by the increased pharmacy costs of PAH drugs, which were USD 19,961 over a six-month period. (11) Healthcare financing in Singapore is built on a tiered co-payment model. The first tier is government subsidies.…”

Section: Discussionmentioning

confidence: 99%

Help-seeking patterns and funding strategies in patients with pulmonary arterial hypertension on phosphodiesterase-5 inhibitors: an orphan disease with effective but costly treatment

Lim¹,

Maaroof²,

Low³

et al. 2021

smedj

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Treatment Patterns and Associated Health Care Costs Before and After Treatment Initiation Among Pulmonary Arterial Hypertension Patients in the United States

Cited by 38 publications

References 20 publications

Retrospective Database Analysis of Treatment Patterns Among Patients with Pulmonary Arterial Hypertension

Retrospective Database Analysis of Treatment Patterns Among Patients with Pulmonary Arterial Hypertension

Medication Adherence and Healthcare Costs Among Patients with Pulmonary Arterial Hypertension Treated with Oral Prostacyclins: A Retrospective Cohort Study

Help-seeking patterns and funding strategies in patients with pulmonary arterial hypertension on phosphodiesterase-5 inhibitors: an orphan disease with effective but costly treatment

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