Applied Health Economics and Health Policy

, Volume 9, Issue 6, pp 377–387 | Cite as

Excess costs associated with patients with chronic thromboembolic pulmonary hypertension in a US privately insured population

  • Noam Y. Kirson
  • Howard G. Birnbaum
  • Jasmina I. Ivanova
  • Tracy Waldman
  • Vijay Joish
  • Todd Williamson
Original Research Article

Abstract

Background

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and potentially fatal disease. Little is known about the economic burden associated with CTEPH patients in the US.

Objectives

The objective of this study was to estimate excess direct costs associated with privately insured patients with CTEPH in the US.

Methods

From a privately insured claims database (>8 million beneficiaries, 2002–7), 289 CTEPH patients were identified using the criteria: two or more claims for pulmonary hypertension (PH), International Classification of Diseases, ninth edition, clinical modification (ICD-9-CM) code 416.0 or 416.8; one or more claim for pulmonary embolism (ICD-9-CM: 415.1, V12.51; ICD-9 procedure: 38.7; Current Procedural Terminology [CPT]-4 code: 36010, 37620, 75825, 75940; Healthcare Common Procedure Coding System [HCPCS] code: C1880) within 12 months prior or 1 month after the initial PH claim (index date); one or more claim for right heart catheterization (RHC) within 6 months prior to any PH claim or one or more claim for echocardiogram within 6 months prior to a specialist-diagnosed PH claim; aged 18–64 years. Patients with CTEPH were matched demographically to controls without PH. Patients were followed as long as continuously eligible; mean follow-up in CTEPH patients was 21.5 months. Chi-squared tests were used to compare baseline co-morbidities. Wilcoxon rank-sum tests were used to compare direct (medical and pharmaceutical) patient-month costs to insurers.

Results

The average age for CTEPH patients was 52.2 years, and 57.1 % were women. Compared with controls, CTEPH patients had significantly higher baseline rates of co-morbidities (e.g. essential hypertension, congestive heart failure and chronic pulmonary disease) and a higher mean Charlson Co-morbidity Index score. Mean direct patient-month costs (year 2007 values) were $US4782 for CTEPH patients and $US511 for controls (p< 0.0001). Sensitivity analysis restricting the sample to patients diagnosed following RHC yielded a 15% increase in excess costs relative to the original sample. Regarding cost drivers, inpatient services accounted for 54%, outpatient and other services for 33% and prescription drugs for 11% of total direct healthcare costs per patient-month in CTEPH patients. Circulatory-/respiratory-related patient-month costs were $US2496 among CTEPH patients and $US128 among controls (p< 0.0001).

Conclusions

CTEPH patients had substantially higher costs and co-morbidity than matched controls, with circulatory-/respiratory-related costs accounting for 55% of excess costs. The high burden of illness suggests opportunities for savings from improved management.

Notes

Acknowledgements

Research and writing support was provided to Analysis Group, Inc. by Bayer HealthCare Pharmaceuticals.

Dr Kirson, Dr Birnbaum, Ms Ivanova and Ms Waldman are employees of Analysis Group, Inc. Dr Joish and Dr Williamson are employees of Bayer HealthCare Pharmaceuticals.

References

  1. 1.
    McLaughlin VV, Archer SL, Badesch DB, et al. ACCF/AHA 2009 expert consensus document on pulmonary arterial hypertension. J Am Coll Cardiol 2009; 53(17): 1573–619PubMedCrossRefGoogle Scholar
  2. 2.
    Simonneau G, Robbins IM, Beghetti M, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2009 Jun 30; 54(1 Suppl.): S43–54PubMedCrossRefGoogle Scholar
  3. 3.
    Hoeper MM, Mayer E, Simonneau G, et al. Chronic thromboembolic pulmonary hypertension. Circulation 2006; 113(16): 2011–20PubMedCrossRefGoogle Scholar
  4. 4.
    Pengo V, Lensing AW, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004 May 27; 350(22): 2257–64PubMedCrossRefGoogle Scholar
  5. 5.
    Lang IM. Chronic thromboembolic pulmonary hypertension: not so rare after all. N Engl J Med 2004; 350: 2236–8PubMedCrossRefGoogle Scholar
  6. 6.
    Suntharalingam J, Treacy CM, Doughty NJ, et al. Long-term use of sildenafil in inoperable chronic thromboembolic pulmonary hypertension. Chest 2008; 134: 229–36PubMedCrossRefGoogle Scholar
  7. 7.
    Jaïs X, D’Armini AM, Jansa P, et al. Bosentan for treatment of inoperable chronic thromboembolic pulmonary hypertension: BENEFiT (bosentan effects in inoperable forms of chronic thromboembolic pulmonary hypertension), a randomized, placebo-controlled trial. J Am Coll Cardiol 2008; 16: 2127–34CrossRefGoogle Scholar
  8. 8.
    Seyfarth HJ, Halank M, Wilkens H, et al. Standard PAH therapy improves long term survival in CTEPH patients. Clin Res Cardiol 2010 Sep; 99(9): 553–6PubMedCrossRefGoogle Scholar
  9. 9.
    Ribeiro A, Lindmarker P, Johnsson H, et al. Pulmonary embolism: one-year follow-up with echocardiography Doppler and five-year survival analysis. Circulation 1999; 99: 1325–30PubMedCrossRefGoogle Scholar
  10. 10.
    Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40(5): 373–83PubMedCrossRefGoogle Scholar
  11. 11.
    Romano PS, Roos LL, Jollis J. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data. J Clin Epidemiol 1993; 46(10): 1075–9PubMedCrossRefGoogle Scholar
  12. 12.
    US Department of Labor, Bureau of Labor Statistics. Consumer price index for medical care, 2009 [online]. Available from URL: http://www.bls.gov/cpi/ [Accessed 2009 Nov 23]Google Scholar
  13. 13.
    Kirson NY, Birnbaum HG, Ivanova JI, et al. Excess costs associated with patients with pulmonary arterial hypertension in US privately insured population. Appl Health Econ Health Policy 2011; 9(5): 293–303PubMedCrossRefGoogle Scholar
  14. 14.
    Birnbaum HG, Mattson ME, Kashima S, et al. Prevalence rates and costs of metabolic syndrome and associated risk factors using employees’ integrated laboratory data and health care claims. J Occup Environ Med 2011 Jan; 53(1): 27–33PubMedCrossRefGoogle Scholar
  15. 15.
    Macchia A, Marchioli R, Marfisi R, et al. A meta-analysis of trials of pulmonary hypertension: a clinical condition looking for drugs and research methodology. Am Heart J 2007; 153: 1037–47PubMedCrossRefGoogle Scholar
  16. 16.
    Ghofrani HA, Wilkins MW, Rich S. Uncertainties in the diagnosis and treatment of pulmonary arterial hypertension. Circulation 2008; 118: 1195–201PubMedCrossRefGoogle Scholar
  17. 17.
    Galie N, Palazzini M, Manes A. Pulmonary arterial hypertension: from the kingdom of the near-dead to multiple clinical trial meta-analyses. Eur Heart J 2010 Sep; 31(17): 2080–6PubMedCrossRefGoogle Scholar
  18. 18.
    White RH. The epidemiology of venous thromboembolism. Circulation 2003; 107(23 Suppl. 1): I4–8PubMedGoogle Scholar
  19. 19.
    Silverstein MD, Heit JA, Mohr DN, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism. Arch Intern Med 1998; 158: 585–93PubMedCrossRefGoogle Scholar
  20. 20.
    National Institutes of Health, US Department of Health and Human Services. What is pulmonary embolism [online]. Available from URL: http://www.nhlbi.nih.gov/health/dci/Diseases/pe/pe_what.html [Accessed 2009 Nov 5]

Copyright information

© Adis Data Information BV 2011

Authors and Affiliations

  • Noam Y. Kirson
    • 1
  • Howard G. Birnbaum
    • 1
  • Jasmina I. Ivanova
    • 2
  • Tracy Waldman
    • 1
  • Vijay Joish
    • 3
  • Todd Williamson
    • 3
  1. 1.Analysis Group, Inc.BostonUSA
  2. 2.Analysis Group, Inc.New YorkUSA
  3. 3.Bayer HealthCare PharmaceuticalsWayneUSA

Personalised recommendations