Medical Costs in Patients with Pulmonary Arterial Hypertension (PAH) on Oral Triple Therapy including Selexipag in the United States (US): A retrospective Claims-Based Study
Author(s)
Carly Worden, MPH, PharmD1, Yuen Tsang, BS, MPH, PharmD2, Louise Yu, MS3, Ambika Satija, ScD4, Marjolaine Gauthier-Loiselle, PhD3;
1Janssen, Director Real World Value & Evidence, Titusville, NJ, USA, 2J&J, Titusville, NJ, USA, 3AG, Montreal, QC, Canada, 4AG, Boston, MA, USA
1Janssen, Director Real World Value & Evidence, Titusville, NJ, USA, 2J&J, Titusville, NJ, USA, 3AG, Montreal, QC, Canada, 4AG, Boston, MA, USA
OBJECTIVES: The 2022 ESC/ERS guidelines for the treatment of pulmonary arterial hypertension (PAH) recommend treating patients to achieve a low-risk status. If low-risk status is not achieved by dual combination therapy, selexipag is recommended as add-on treatment to reduce morbidity and mortality. Studies have examined the real-world effectiveness of selexipag on clinical outcomes, but very few have examined costs. Therefore, this study assessed medical costs among PAH patients on triple therapy with macitentan+phosphodiesterase type 5 inhibitors(PDE5i)+selexipag in the United States(US).
METHODS: The Komodo Health Research US claims database (01/2016−03/2023) was used to identify adult patients with PAH initiated on macitentan+PDE5i+selexipag (index date: initiation date of first new drug in the regimen; baseline: 6 months pre-index). A 60-day window was used to identify treatment regimens. Medical costs were assessed per patient per month (PPPM) during the study period (≤12 months post-index until first of death, end of continuous enrollment, and data availability); PAH-related costs were identified from medical claims with a PAH-related diagnosis (ICD-10-CM: I27.0, I27.20, I27.21, I27.89).
RESULTS: A total of 413 patients were included. Baseline patient demographic and clinical characteristics were typical for a PAH cohort on triple therapy (median age: 52 years; 72.6% female; 42.6% White). During the baseline period, 14.3% did not receive any PAH treatment, 9.7% received 1 treatment class, 61.5% received 2 classes, and 14.5% received 3 or more treatment classes. All-cause medical costs with a median of $932 PPPM were skewed by a few high-cost individuals (mean: $3,237; SD: $6,229). PAH-related medical costs followed a similar pattern with a median of $321 PPPM (mean: $1,857; SD: $4,302).
CONCLUSIONS: In this retrospective claims-based analysis, our findings suggest that patients with PAH on this triple oral therapy incur high medical costs. However, they remain medically complex patients as their all-cause costs were nearly three times higher than their PAH-related costs.
METHODS: The Komodo Health Research US claims database (01/2016−03/2023) was used to identify adult patients with PAH initiated on macitentan+PDE5i+selexipag (index date: initiation date of first new drug in the regimen; baseline: 6 months pre-index). A 60-day window was used to identify treatment regimens. Medical costs were assessed per patient per month (PPPM) during the study period (≤12 months post-index until first of death, end of continuous enrollment, and data availability); PAH-related costs were identified from medical claims with a PAH-related diagnosis (ICD-10-CM: I27.0, I27.20, I27.21, I27.89).
RESULTS: A total of 413 patients were included. Baseline patient demographic and clinical characteristics were typical for a PAH cohort on triple therapy (median age: 52 years; 72.6% female; 42.6% White). During the baseline period, 14.3% did not receive any PAH treatment, 9.7% received 1 treatment class, 61.5% received 2 classes, and 14.5% received 3 or more treatment classes. All-cause medical costs with a median of $932 PPPM were skewed by a few high-cost individuals (mean: $3,237; SD: $6,229). PAH-related medical costs followed a similar pattern with a median of $321 PPPM (mean: $1,857; SD: $4,302).
CONCLUSIONS: In this retrospective claims-based analysis, our findings suggest that patients with PAH on this triple oral therapy incur high medical costs. However, they remain medically complex patients as their all-cause costs were nearly three times higher than their PAH-related costs.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE227
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)