Pulmonary Hypertension Due to Interstitial Lung Disease Increases Healthcare Use
Presenter: Gustavo A. Heresi, MD, MS, Director, Pulmonary Vascular and Chronic Thromboembolic Pulmonary Hypertension Program, Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
A summary of Burden of Illness in Patients with Pulmonary Hypertension Due To Interstitial Lung Disease: A Real-World Analysis Using US Claims Data, presented October 18, 2021.
Pulmonary hypertension (PH) due to interstitial lung disease (ILD) progresses rapidly and is associated with poor survival, decreased quality of life, and worse outcomes. A retrospective cohort study identified patients diagnosed with PH from June 1, 2016, through June 30, 2018, using the MarketScan commercial database and Medicare supplemental databases. The date of first PH diagnosis was deemed the index date.
Patients were aged 18 years or older at index and were required to have an ILD diagnosis in the 12 months pre-index as well as continuous enrollment in a health plan 12 months pre-index through 12 months post-index. Patients were excluded if they had a PH diagnosis prior to any ILD diagnosis, had any medical claim with a diagnostic code for non-ILD group 3 PH (ie, PH groups 2, 4, 5), or had at least 1 inpatient or 2 outpatient medical claims less than 30 days apart that contained a PH diagnosis.
“Outcomes of interest included treatment patterns, hospitalization, intensive care unit stays, and medical and pharmacy costs, which were quantified in the 12 months pre- vs post-index period,” Heresi said.
In total, 122 patients with PH-ILD met the study’s selection criteria. Their mean age at index was 63.7 years, and most patients were female (64.7%). Patients were well-distributed across geographic region and payer type. The mean Charlson-Comorbidity Index score was 3.2, which is suggestive of a significantly highly comorbid population, according to Heresi.
He noted that the proportion of patients using corticosteroids, calcium channel blockers, and oxygen increased after a PH diagnosis. Corticosteroids use increased from 43% to 54%, calcium channel blockers from 25% to 37%, and oxygen from 12% to 25%.
“In the post-index period, 9% of patients were being treated with an antifibrotic agent, and very few initiated pulmonary arterial hypertension-specific medications,” Heresi said. “Prior to index, 29.5% of patients experienced hospitalization. After the PH diagnosis, 59% of patients experienced a hospitalization. The severity of hospitalizations increased with significant increases in mean length of stay, from 5.4 days to 7.5 days, and a 161% increase in percent of patients requiring intensive care. This resulted in an increase in healthcare utilization that was reflected in increased costs, with a 151% increase in mean total costs in the 12 months post-index period.”
In conclusion, Heresi said, “Following the initial diagnosis of PH due to ILD, patients have significantly increased utilization of healthcare resources, including inpatient admissions. Healthcare costs significantly increase after diagnosis of PH-ILD, largely driven by medical costs. Thus, timely management and treatment of PH-ILD is needed to mitigate the clinical and economic consequences of disease progression.”
Disclosures
Gustavo Heresi, MD: Actelion (Consulting fee), Bayer Healthcare (Consulting fee/Speaker’s bureau)
Reference
Heresi, G, Castillo H, Lee H, et al. Burden of illness in patients with pulmonary hypertension due to interstitial lung disease: a real-world analysis using US claims data. Chest. 2021;160(4):A2322–A2323. doi: 10.1016/j.chest.2021.07.2017. Accessed October 19, 2021.