IMPACT OF PULMONARY ARTERIAL HYPERTENSION ON HEART-LUNG TRANSPLANTATION OUTCOMES AND COSTS IN THE BRAZILIAN PUBLIC HEALTH SYSTEM
Author(s)
Amanda A. Bittencourt, MD1, Antônio C. Gaspar, BSc2, Bruna P. Nascimento, PhD1, Paula de Mendonça Batista, MBA, PharmD1, Jacqueline P. Albor, MD3, Marcia M. Oliveira, PhD1, Haliton A. Oliveira Jr., PhD4;
1Merck Sharp & Dohme, Global Medical and Scientific Affairs, Sao Paulo, Brazil, 2Heads in Health, São Paulo, Brazil, 3Merck Sharp & Dohme, Global Medical and Scientific Affairs, Bogota, Colombia, 4Merck Sharp & Dohme, São Paulo, Brazil
1Merck Sharp & Dohme, Global Medical and Scientific Affairs, Sao Paulo, Brazil, 2Heads in Health, São Paulo, Brazil, 3Merck Sharp & Dohme, Global Medical and Scientific Affairs, Bogota, Colombia, 4Merck Sharp & Dohme, São Paulo, Brazil
OBJECTIVES: Pulmonary arterial hypertension (PAH) is a severe condition that can progress to right heart failure, requiring advanced interventions like heart/lung transplantation. This study describes the clinical and economic burden of these procedures in Brazilian Public Health System (SUS), focusing on PAH patients.
METHODS: We conducted a retrospective cohort study using structured secondary data from DATASUS, the official health information system of SUS, from January 2019 to June 2025. The cohort was constructed by identifying PAH patients with an ICD I27.0 diagnosis code and at least one record indicating hospitalization, outpatient visit, procedure, or medication related to PAH, along with procedure records for heart/lung transplantation in Hospital Information System (SIH), with the first instance serving as index date. Variables included total number of heart/lung transplants, average length of hospital stay, and average cost per procedure during transplantation.
RESULTS: Over the study period, 2,130 heart transplants, 315 bilateral lung transplants, and 116 unilateral lung transplants were performed in SUS. Cross-referencing DATASUS datasets identified 19 transplants in PAH patients: 1 heart and 18 bilateral lung transplants. Of these 19 patients, 5 were male and 14 females; 4 were aged ≤18 years, 12 were 19-59 years, and 1 was 60-69 years. Hospitalizations for these patients accounted for 1,355 inpatient days before and after transplantation, with an approximate total cost of R$2,605,298.23 (≈ US$510,842.79), including procedures before and after transplant. The average length of stay per patient was 71.3 days. These findings underscore considerable resource utilization and clinical complexity in managing advanced PAH within SUS.
CONCLUSIONS: Heart/lung transplants in SUS represent a significant clinical and economic burden, characterized by prolonged hospitalization and high costs. Despite this, access to transplantation for PAH patients remains limited, representing a small fraction of total procedures. These findings highlight the need for strategies to optimize outcomes for PAH patients in Brazil.
METHODS: We conducted a retrospective cohort study using structured secondary data from DATASUS, the official health information system of SUS, from January 2019 to June 2025. The cohort was constructed by identifying PAH patients with an ICD I27.0 diagnosis code and at least one record indicating hospitalization, outpatient visit, procedure, or medication related to PAH, along with procedure records for heart/lung transplantation in Hospital Information System (SIH), with the first instance serving as index date. Variables included total number of heart/lung transplants, average length of hospital stay, and average cost per procedure during transplantation.
RESULTS: Over the study period, 2,130 heart transplants, 315 bilateral lung transplants, and 116 unilateral lung transplants were performed in SUS. Cross-referencing DATASUS datasets identified 19 transplants in PAH patients: 1 heart and 18 bilateral lung transplants. Of these 19 patients, 5 were male and 14 females; 4 were aged ≤18 years, 12 were 19-59 years, and 1 was 60-69 years. Hospitalizations for these patients accounted for 1,355 inpatient days before and after transplantation, with an approximate total cost of R$2,605,298.23 (≈ US$510,842.79), including procedures before and after transplant. The average length of stay per patient was 71.3 days. These findings underscore considerable resource utilization and clinical complexity in managing advanced PAH within SUS.
CONCLUSIONS: Heart/lung transplants in SUS represent a significant clinical and economic burden, characterized by prolonged hospitalization and high costs. Despite this, access to transplantation for PAH patients remains limited, representing a small fraction of total procedures. These findings highlight the need for strategies to optimize outcomes for PAH patients in Brazil.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE105
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Rare & Orphan Diseases