OBJECTIVES : Pulmonary Arterial Hypertension (PAH) is a rare, severe disease. Registries report low 5-year survival rates that worsen with disease progression (i.e. functional class (FC)). The aim of this study is to describe aspects of clinical practice and healthcare resource utilization in PAH for Brazilian public healthcare system.

METHODS : Descriptive study, based on surveys conducted with six experts in treating PAH in referential public hospitals. Physicians treated 1,045 patients in the 12 months prior to the survey. Descriptive statistics were applied to summarize the findings. Treatment patterns and hospitalization were analyzed by patient’s risk stratification or FC.

RESULTS : Most physicians (67%) stratified patients by risk. Intermediate risk group is larger (IR: 51%, n=537) than high (HR: 23%, n=243) and low risk (LR: 25%, n= 265). On average, 53% of patients at LR were treated with monotherapy, while 21% and 26% received upfront combination (PED5i+ERA) and sequential therapy, respectively. Monotherapy was not reported in clinical practice for patients at IR or HR. Instead, 34% of those patients were treated with upfront combination and 66% with sequential therapy. Double therapy was used in 47%, 99% and 74%, and triple therapy at 0%, 1% and 26% of the patients at LR, IR and HR, respectively. IR (9%) and HR (42%) patients required hospitalizations, with an average stay of 8 and 22 days, respectively. While 88% of those at IR were hospitalized once a year, 61% at HR were hospitalized 2+ times a year.

CONCLUSIONS : Healthcare resource utilization was higher in patients with more progressed PAH, considering medication/hospitalization needs, reflecting in costs 56% higher. Combination therapy (double/triple) has limited use in Brazil and this might be due to 2014 PAH Brazilian protocol that recommends monotherapy, however international guidelines and evidence suggest that patients could benefit from it in earlier stages to prevent disease progression and lower hospitalization burden.