Economic Burden of Delayed Diagnosis in Patients with Pulmonary Arterial Hypertension (PAH)

• Published in: PharmacoEconomics - open 2024-01, Vol.8 (1), p.133-146
• Main Authors: DuBrock, Hilary M., Germack, Hayley D., Gauthier-Loiselle, Marjolaine, Linder, Jörg, Satija, Ambika, Manceur, Ameur M., Cloutier, Martin, Lefebvre, Patrick, Panjabi, Sumeet, Frantz, Robert P.
• Format: Article
• Language: English
• Subjects: Ascites; Cardiac arrhythmia; Cardiac catheterization; Clinical outcomes; Comorbidity; Costs; Cyanosis; Drug dosages; Dyspnea; Edema; Health care expenditures; Health care policy; Health insurance; Hospitalization; Intensive care; Intubation; Medicine; Medicine & Public Health; Mortality; Original; Original Research Article; Patients; Pharmacoeconomics and Health Outcomes; Pulmonary hypertension; Thromboembolism
• ISSN: 2509-4262; 2509-4254; 2509-4254
• DOI: 10.1007/s41669-023-00453-8

Background The aim of this study was to assess health care resource utilization (HRU) and costs associated with delayed pulmonary arterial hypertension (PAH) diagnosis in the United States. Methods Eligible adults with newly diagnosed PAH from Optum’s de-identified Clinformatics ® Data Mart Database (2016–2021) were assigned to mutually exclusive cohorts based on time between first PAH-related symptom and first PAH diagnosis (i.e., ≤12 months’ delay, >12 to ≤24 months’ delay, >24 months’ delay). All-cause HRU and health care costs per patient per month (PPPM) were assessed during the first year following diagnosis and compared across cohorts using regression analysis adjusted for baseline covariates. Sensitivity analyses were conducted to assess outcomes during all available follow-up post-diagnosis. Results Among 538 patients (mean age: 65.6 years; 60.6% female), 60.8% had ≤12 months’ delay, 23.4% had a delay of >12 to ≤24 months, and 15.8% had >24 months’ delay. Compared with ≤12 months, delays of >12 to ≤24 months and >24 months were associated with increased hospitalizations (incidence rate ratio [95% confidence interval]: 1.40 [1.11–1.71] vs 1.71 [1.29–2.12]) and outpatient visits (1.17 [1.06–1.30] vs 1.26 [1.08–1.41]). Longer delays were also associated with more intensive care unit (ICU) stays and 30-day readmissions. Diagnosis delays translated into excess costs PPPM of US$3986 [1439–6436] for >12 to ≤24 months and US$5366 [2107–8524] for >24 months compared with ≤12 months’ delay; increased hospitalization costs (US$3248 [1108–5135] and US$4048 [1401–6342], respectively) being the driver. Sensitivity analyses yielded similar trends. Conclusions Delayed PAH diagnosis is associated with significant incremental economic burden post-diagnosis, driven by hospitalizations including ICU stays and 30-day readmissions, highlighting the need for increased awareness and a potential benefit of earlier screening.