OBJECTIVES: Pulmonary arterial hypertension (PAH) is a rare, progressive, and fatal disease associated with elevated pulmonary arterial pressure resulting in right heart failure and death. While several studies have estimated the direct cost of PAH, few have estimated indirect costs. This study examined direct and indirect healthcare burden associated with PAH.

METHODS: Prevalent and incident PAH patients aged 18-64 years were identified from the MarketScan Commercial and Health and Productivity management datasets during the identification period (01JAN2016-30NOV2018). Index date was the date of first PAH diagnosis claim (cases). Patients without PAH were selected (controls) and assigned a random index date during the identification period. Controls were matched 1:1 to prevalent and incident PAH cases. Continuous enrollment ≥12 months pre- and ≥1-month post-index date (follow-up) was also required. Per patient per month all-cause healthcare utilization (HCRU), costs, and short-term disability (STD) were examined for cases and controls post-index date until the first observation of end of employment, continuous enrollment, study, or death. Multivariate analysis was performed using the generalized linear model.

RESULTS: A total of 1293 prevalent and 455 incident PAH patients were identified. During the follow-up period, prevalent PAH patients had significantly higher total mean all-cause healthcare costs ($9,915 vs $359), and inpatient length of stay (LOS) (0.63 vs 0.02 days) compared with controls. Prevalent PAH patients had higher STD (6.1 vs 1.5 days), and STD-related costs ($1226 vs $277) compared to controls. Incident PAH patients had a significantly higher total mean all-cause healthcare costs ($9,353 vs $336), and inpatient LOS (0.92 vs 0.01 days) compared with controls. Incident PAH patients had higher STD (8.1 vs 1.5 days) and STD-related costs ($1706 vs $263) compared to controls.

CONCLUSIONS: This study showed that incident and prevalent PAH patients had significantly higher direct and indirect costs and HCRU compared to controls.