PCV36 - Health Care Costs And Resource Utilization Prior To Initiation Of A Prostacyclin Receptor Agonist For Pulmonary Arterial Hypertension In A Real-World Database Representing A Large US Health Plan

Abstract

Pulmonary arterial hypertension (PAH) is a chronic and progressive disease characterized by abnormally high pressure in the pulmonary arterioles, with increased pulmonary vascular resistance that can result in right heart failure and premature mortality. This study examined the health care resource utilization (HCRU) and cost among patients with PAH in the year prior to treatment with selexipag, an oral selective IP prostacyclin receptor agonist agent. Patients with a diagnosis code for pulmonary hypertension and a prescription fill for selexipag identified by pharmacy claims between January 2016 and May 2017 were included. Patients were ≥18 years old with continuous enrollment in a large US health plan with medical and pharmacy coverage for 1 year (baseline period) before initiation of selexipag. Diagnosis, pharmacy, and medical codes were used to identify baseline comorbidities and medications. HCRU and cost were examined during the baseline period and the 6 months after selexipag initiation. The study included 95 patients, mostly female (70.5%) with mean (±SD) age 61.8±13.8 years, Charlson score 3.6±2.3, and 67.4% enrolled in Medicare Advantage plans. Common comorbidities included hypertension (81.1%), heart failure (64.2%), sleep apnea (41.1%), and type 2 diabetes mellitus (26.3%). Baseline inpatient admissions occurred in 41.9% and 51.6% of commercial and MAPD enrollees, respectively. Mean all-cause baseline medical costs were $46,024 for commercial enrollees and $57,581 for MAPD enrollees, and increased 266.8% and 26.7%, respectively, from the first to the last quarter prior to selexipag initiation. In 42 patients with six months of follow-up after initiation, mean all-cause medical costs were $17,215 and $23,976 for commercial and MAPD enrollees, respectively. Patients with PAH presented with complex comorbidity profiles, and a high percentage were admitted for inpatient stays in the year prior to initiation of selexipag. Prior to initiation, mean all-cause baseline medical costs substantially increased over time, particularly among commercial enrollees.