Changes in healthcare utilization and costs associated with sildenafil therapy for pulmonary arterial hypertension: a retrospective cohort study

BMC Pulmonary Medicine

Gerry Oster¹  Marko A Mychaskiw³  Simon Teal²  John Edelsberg¹  Ariel Berger¹ 

[1] Policy Analysis Inc. (PAI), 4 Davis Court, Brookline, MA, 02445, USA;Pfizer Ltd., Walton Oaks, Dorking Road, Walton-on-the-Hill, Tadworth, Surrey, KT20 7NS, UK;Pfizer Inc., New York, NY, 10017, USA

关键词: Utilization;    Health expenditure;    PDE5, Phosphodiesterase type 5;    Sildenafil;    Primary pulmonary hypertension;    Pulmonary arterial hypertension;   

Others  :  1136300
DOI  :  10.1186/1471-2466-12-75

 received in 2012-06-15, accepted in 2012-12-05,  发布年份 2012

【 摘 要 】

Background

Little is known concerning the degree to which initiation of sildenafil for pulmonary arterial hypertension (PAH) impacts patterns of healthcare utilization and costs.

Methods

Using a large US health insurance claims database, we identified all patients with evidence of PAH (ICD-9-CM diagnosis codes 416.0, 416.8) who received sildenafil between 1/1/2005 and 9/30/2008. Date of the first-noted prescription for sildenafil was designated the “index date,” and claims data were compiled for all study subjects for 6 months prior to their index date (“pretreatment”) and 6 months thereafter (“follow-up”); patients with incomplete data during either of these periods were excluded. Healthcare utilization and costs were then compared between pretreatment and follow-up for all study subjects.

Results

A total of 567 PAH patients were identified who began therapy with sildenafil and met all other study entry criteria. Mean (SD) age was 52 (10) years; 73% were women. Healthcare utilization was largely unchanged between pretreatment and follow-up, the only exceptions being decreases in the mean number of emergency department visits (from 0.7 to 0.5 per patient; p < 0.01) and the percentage of patients hospitalized (from 35% to 29%; p = 0.01). The mean cost of all PAH-related medication was $7139 during pretreatment and $14,095 during follow-up (sildenafil cost during follow-up = $5236); exclusive of PAH-related medications, however, total healthcare costs decreased modestly (from $30,104 to $27,605) (p < 0.01 for all comparisons).

Conclusions

The cost of sildenafil therapy may be partially offset by reductions in other healthcare costs.

【 授权许可】

   
2012 Berger et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, et al.: Guidelines for the diagnosis and treatment of pulmonary hypertension: The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation. Eur Heart J 2009, 30:2493-2537.
• [2]Channick R, Williamson TL: Diagnosis and treatment of pulmonary arterial hypertension. Cardiol Clin 2004, 22:441-452.
• [3]Rich S, Dnatzker DR, Ayres SM, Bergofsky EH, Brundage BH, Detre KM, et al.: Primary pulmonary hypertension. A national prospective study. Ann Intern Med 1987, 107:216-223.
• [4]Simonneau G, Robbins IM, Beghetti M, Channick RN, Delcroix M, Denton CP, Elliott CG, Gaine SP, Gladwin MT, Jing ZC, Krowka MJ, Langleben D, Nakanishi N, Souza R: Updated Clinical Classification of Pulmonary Hypertension. J Am Coll Cardiol 2009, 54:S32-S42.
• [5]Peacock AJ, Murphy NF, McMurray JJV, Caballero L, Steward S: An epidemiologic study of pulmonary arterial hypertension. Eur Respir J 2007, 30:104-109.
• [6]Thenappan T, Shah SJ, Rich S, Gomberg-Maitland M: A USA-based registry for pulmonary arterial hypertension: 1982–2006. Eur Respir J 2007, 30:1103-1110.
• [7]Humbert M, Sitbon O, Chaouat A, Bertocchi M, Habib G, Gressin V, et al.: Pulmonary arterial hypertension in France: Results from a national registry. Am J Respir Crit Care Med 2006, 173:1023-1030.
• [8]Badesch DB, Champion HC, Sanchez MAG, Hoeper MM, Loyd JE, Manes A, et al.: Diagnosis and assessment of pulmonary arterial hypertension. J Am Coll Cardiol 2009, 54:S55-S66.
• [9]D’Alonzo GE, Barst RJ, Ayres SM, Bergofsky EH, Brundage BH, Detre KM, et al.: Survival in patients with primary pulmonary hypertension: Results from a national prospective registry. Ann Intern Med 1991, 115:343-349.
• [10]National Library of Medicine Medical Encyclopedia [http://www.nlm.gov/medlineplus/ency/article/000112.htm]
• [11]Barst RJ, Gibbs JS, Ghofrani HA, Hoeper MM, McLaughlin VV, Rubin LJ, et al.: Updated evidence-based treatment algorithm in pulmonary arterial hypertension. J Am Coll Cardiol 2009, 54:S78-S84.
• [12]Hamilton N: Therapy Review: An independent review of the currently available data for treatment of hypertension in the UK. South Yorkshire: Pulmonary Hypertension Association UK; 2006.
• [13]Galie N, Manes A, Negro L, Palazzini M, Bacchi-Reggiani ML, Branzi A: A meta-analysis of randomized controlled trials in pulmonary arterial hypertension. Eur Heart J 2009, 30:394-403.
• [14]Revatio® prescribing information [http://media.pfizer.com/files/products/uspi_revatio.pdf]
• [15]Deyo RA, Cherkin DC, Ciol MA: Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992, 45:613-619.
• [16]Ghofrani HA, Wiederman R, Rose F, Olschewski H, Schermuly RT, Weissmann N, et al.: Combination therapy with oral sildenafil and inhaled iloprost for severe pulmonary hypertension. Ann Intern Med 2002, 136:515-522.
• [17]Sastry BKS, Narasimhan C, Reddy NK, Raju BS: Clinical efficacy of sildenafil in primary pulmonary hypertension: A randomized, placebo-controlled, double-blind, crossover study. J Am Coll Cardio 2004, 43:1149-1153.
• [18]Simonneau G, Rubin LJ, Galie N, Barst RJ, Fleming TR, Frost AE, et al.: Addition of sildenafil to long-term intravenous epoprostenol therapy in patients with pulmonary arterial hypertension: A randomized clinical trial. Ann Intern Med 2008, 149:521-530.
• [19]Badesch DB, Hill NS, Burgess G, Rubin LJ, Barst RJ, Galie N, et al.: Sildenafil for pulmonary arterial hypertension associated with connective tissue disease. J Rheumatol 2007, 34:2417-2422.
• [20]Wilkins MR, Paul GA, Strange JW, Tunariu N, Gin-Sing W, Banya WA, et al.: Sildenafil versus endothelin receptor antagonist for pulmonary hypertension (SERAPH) study. Am J Respir Crit Care Med 2005, 171:1292-1297.
• [21]Galie N, Ghofrani HA, Torbicki A, Barst RJ, Rubin LJ, Badesch D, et al.: Sildenafil citrate therapy for pulmonary arterial hypertension. N Eng J Med 2005, 353:2148-2157.
• [22]Lewis GD, Shah R, Shahzad K, Camuso JM, Pappagianopoulos PP, Hung J, et al.: Sildenafil improves exercise capacity and quality of life in patients with systolic heart failure and secondary pulmonary hypertension. Circulation 2007, 116:1555-1562.
• [23]Pepke-Zaba J, Gilbert C, Collings L, Brown MCJ: Sildenafil improves health-related quality of life in patients with pulmonary arterial hypertension. Chest 2008, 133:183-189.
• [24]Singh TP, Rohit M, Grover A, Malhotra S, Vijayvergiya R: A randomized, placebo-controlled, double-blind, crossover study to evaluate the efficacy of oral sildenafil therapy in severe pulmonary artery hypertension. Am Heart J 2006, 151:851. e1-5.