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

Appl Health Econ Health Policy. 2011 Sep 1;9(5):293-303. doi: 10.2165/11592430-000000000-00000.


Background: Pulmonary arterial hypertension (PAH) is a rare but fatal disease. Little is known about the economic burden associated with PAH patients in the US.

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

Methods: From a privately insured claims database (>8 million beneficiaries, 2002-7), 471 patients with PAH were identified using the criteria: two or more claims for primary pulmonary hypertension (PH), International Classification of Diseases, ninth edition, clinical modification (ICD-9-CM) code 416.0; no left heart disease, lung diseases, chronic thromboembolic PH or miscellaneous PH diagnoses 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 PAH were matched demographically to controls without PH. Patients were followed as long as continuously eligible; mean follow-up of PAH patients was 24.8 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 PAH patients was 52.2 years, and 55.8% were women. Compared with controls, PAH patients had significantly higher baseline rates of co-morbidities (e.g. essential hypertension, diabetes mellitus and congestive heart failure) and a higher mean Charlson Co-morbidity Index score. Mean direct patient-month costs (year 2007 values) were $US2023 for PAH patients and $US498 for controls (p < 0.0001), yielding excess costs of $US1525. Sensitivity analysis restricting the sample to patients diagnosed following RHC yielded a 64% increase in excess costs relative to the original sample. Regarding cost drivers, inpatient services accounted for 45%, outpatient and other services for 38% and prescription drugs for 15% of total direct healthcare costs per patient-month in PAH patients. Circulatory/respiratory system-related patient-month costs were $US724 among PAH patients and $US114 among controls (p < 0.0001).

Conclusions: Patients with PAH had substantially higher costs and co-morbidity than controls, with circulatory/respiratory system-related costs accounting for 40% of excess costs. The high burden of illness suggests opportunities for savings from improved management.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Familial Primary Pulmonary Hypertension
  • Female
  • Health Care Costs
  • Humans
  • Hypertension, Pulmonary / economics*
  • Hypertension, Pulmonary / therapy*
  • Insurance, Health / economics*
  • Insurance, Health / statistics & numerical data*
  • Male
  • Middle Aged
  • United States
  • Young Adult