OBJECTIVES: To assess the current economic burden of hospitalizations related to pulmonary arterial hypertension (PAH) in France.

METHODS: A retrospective database analysis (HO-15-16391 study, funded by GSK) was performed using the French national hospital discharge database (PMSI-MCO, 2013). All hospital stays in 2013 with PAH ICD-10 codes (I27.0, I27.2) as principal or associated diagnosis were extracted. Only incident adult patients were analyzed (not hospitalized with PAH in 2011-2012). A medically pre-defined selection algorithm was completed with the input of medical experts in order to exclude any patient identified as presenting with another pulmonary hypertension group. Patients were followed for a year following their index stay. A separate algorithm and a medical review excluded hospitalizations not related to PAH, and classified selected admissions as inclusion (diagnosis, treatment initiation), monitoring and worsening, based on the delay of admission occurrence, length of stay, reason for hospitalization, presence of certain comorbidities and death. Hospital costs associated with PAH management were estimated using published official tariffs in France for 2013 and 2014 expressed in 2015 Euro.

RESULTS: A cohort of 384 patients newly diagnosed with PAH was identified. Mean age of patients was 59.6 years old (±16.7), 63% were female. The 1,271 hospital stays were classified as: 415 inclusion stays (32.7%), 604 PAH monitoring stays (47.5%) and 252 PAH worsening stays (19.8%).

The annual economic burden of hospitalizations for PAH was estimated to €3.6 million with inclusion stays accounting for 28%; monitoring stays for 21%; worsening stays for 51%. The median cost per stay was estimated to be €1,535 [336-108,668], varying from €1,269 [362-6,825] for monitoring stays to €4,121 [518-108,668] for worsening stays. Four patients (1%) had a lung transplantation, which accounted for 10% of total costs (€357,277).

CONCLUSIONS: PAH worsening is a major driver of hospital-related costs supporting the relevance of clinically validated therapeutic strategies preventing disease progression.