Abstract
BackgroundLittle is known concerning the degree to which initiation of sildenafil for pulmonary arterial hypertension (PAH) impacts patterns of healthcare utilization and costs.MethodsUsing a large US health insurance claims database, we identified all patients with evidence of PAH (ICD-9-CM diagnosis codes 416.0, 416.8) who received sildenafil between 1/1/2005 and 9/30/2008. Date of the first-noted prescription for sildenafil was designated the “index date,” and claims data were compiled for all study subjects for 6 months prior to their index date (“pretreatment”) and 6 months thereafter (“follow-up”); patients with incomplete data during either of these periods were excluded. Healthcare utilization and costs were then compared between pretreatment and follow-up for all study subjects.ResultsA total of 567 PAH patients were identified who began therapy with sildenafil and met all other study entry criteria. Mean (SD) age was 52 (10) years; 73% were women. Healthcare utilization was largely unchanged between pretreatment and follow-up, the only exceptions being decreases in the mean number of emergency department visits (from 0.7 to 0.5 per patient; p < 0.01) and the percentage of patients hospitalized (from 35% to 29%; p = 0.01). The mean cost of all PAH-related medication was $7139 during pretreatment and $14,095 during follow-up (sildenafil cost during follow-up = $5236); exclusive of PAH-related medications, however, total healthcare costs decreased modestly (from $30,104 to $27,605) (p < 0.01 for all comparisons).ConclusionsThe cost of sildenafil therapy may be partially offset by reductions in other healthcare costs.
Highlights
Little is known concerning the degree to which initiation of sildenafil for pulmonary arterial hypertension (PAH) impacts patterns of healthcare utilization and costs
We included patients with either of these diagnosis codes to ensure complete capture of all those with PAH, since the ICD-9-CM coding system does not coincide with contemporary classification schemes for pulmonary hypertension. We identified those with one or more pharmacy claims for Revatio, the commercial name of sildenafil that is indicated for the treatment of PAH
We identified a total of 567 patients with evidence of PAH who began therapy with sildenafil and satisfied all other entry criteria (Table 2)
Summary
Little is known concerning the degree to which initiation of sildenafil for pulmonary arterial hypertension (PAH) impacts patterns of healthcare utilization and costs. Pulmonary arterial hypertension (PAH) is characterized by a pathological narrowing of the pulmonary arterioles and small arteries, which causes elevated pulmonary vascular resistance and increased pressure in the pulmonary arteries and eventually results in the development of right ventricular failure and death [1,2]. The disease is one form of pulmonary hypertension (broadly defined as increased pressure in the pulmonary arteries, capillaries, or veins). Mean age at diagnosis is >50 years, and the disease is more common among women than men. Most patients present with moderate-to-severe disease and prognosis is poor; 5-year survival in the absence of treatment is only about 50% [9]
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