Treatment History, Healthcare Resource Use, and Costs Among Patients With Pulmonary Arterial Hypertension (PAH) Initiating Treatment With Macitentan: A Retrospective Claims Analysis

OBJECTIVES: Early combination therapy is associated with delayed disease progression in patients with PAH. The objective of this study was to describe patient characteristics, treatment history, healthcare resource use (HCRU), and costs among patients initiating macitentan for the treatment of PAH.

METHODS: A retrospective cohort study was conducted using US claims data from Optum's de-identified Clinformatics® Data Mart Database. Patients ≥18 years old with PAH initiating macitentan between January 2014-December 2021 were included. Patients with evidence of lung transplant or atrial septostomy, chronic thromboembolic pulmonary hypertension, or acute pulmonary embolism were excluded. Demographic and clinical characteristics, macitentan initiation and therapies prescribed within the prior 12 months were analyzed descriptively. HCRU and costs per patient per month (PPPM) following macitentan initiation were summarized.

RESULTS: 1,138 patients were included in the study; median (mean) duration of follow-up was 19 (25.4) months. Most patients were ≥65 years old (60%), female (73%), and Medicare-insured (71%). Mean Charlson Comorbidity Index was 3.0. Prior therapy consisted of phosphodiesterase-5 inhibitors (PDE5i) only (24%), other endothelin receptor antagonist (ERA) only (6%), PDE5i and other ERA (6%), and no prior treatment (63%; treatment-naïve). Among treatment-naïve patients, 31% initiated a PDE5i within 90 days of macitentan initiation. Patients received a mean of 6.35 prescription medications PPPM. A mean of 0.09 inpatient admissions, 5.80 outpatient services (0.12 emergency room visits, 1.37 outpatient hospital visits, 1.51 office visits, 1.01 home health visits, 1.11 lab and imaging services, 0.14 medication administrations, and 0.51 other outpatient services) PPPM occurred during follow-up. Total healthcare costs were $19,140 PPPM.

CONCLUSIONS: Most macitentan initiators are treatment-naïve and only one third add a PDE5i within 90 days. Total HCRU and costs in these patients are substantial, which concurs with other studies in this population. A single-tablet combination therapy could provide these naïve patients upfront guideline-recommended care and prevent delays to combination therapy.