Majority of Costs for Advanced PAH are for Medications | 2024 ATS

Medications to treat patients with pulmonary arterial hypertension contribute significantly to payer costs, finds a new real-world study of claim data. This poster was presented recently at the American Thoracic Society 2024 International Conference.

Pulmonary arterial hypertension is a rare, progressive and life-threatening disease in which blood vessels in the lungs narrow, causing strain on the heart. About 40,000 people in the United States are living with PAH. The five-year mortality rate is about 43%.

Researchers in this study, which was sponsored by Merck, wanted to assess the economic burden on patients who were treated with parenteral prostacyclin compared with other therapies. Prostacyclin — including several generic and branded therapies — dilate blood vessels and improve blood flow while also preventing blood clotting.

Anna Watzker

In this study, researchers used prostacyclin as a proxy or marker for advanced disease; parenteral prostacyclin (pPCA) is used in the most advanced patients, in addition to other PAH therapies, in alignment with guidelines, Anna Watzker, associate director, outcomes research at Merck, said by email.

“The study relies on a claims data source, which limits our ability to assess disease severity. However, by using pPCA as a proxy, we can provide a recent real-world perspective on the cost burden in PAH patients revealing an increasingly high burden for patients as their condition advances. We hope this study will aid in raising awareness of the burden faced by the most advanced PAH patients.”

This study assessed the costs of 11,670 adult patients with Medicare and 1,174 patients with commercial insurance who had been diagnosed with pulmonary arterial hypertension between Jan. 1, 2019, and Nov. 30, 2020. Researchers assessed claims data from three different sources: Milliman’s Consolidated Health Cost Guidelines Source Databased and IBM’s MarketScan for patients with commercial insurance, as well as 100% Medicare Research Identifiable Files.

Per patient per month (PPPM) costs were assessed separately for medical and pharmacy costs and summarized by the amounts paid by payer, excluding patient cost-sharing.

This study found that the majority of costs incurred are for medications, contributing on average between 69% and 88% of monthly payer costs. Among Medicare beneficiaries at end of life, medications still contributed to the majority (59%) of costs among patients receiving parenteral prostacyclin,

The cost for people with commercial insurance was $26,944 per patient per month compared with $13,992 those who did not receive prostacyclin. For those with Medicare, the per patient per month cost for those who received prostacyclin was $20,323 compared with $8,694 compared with those who did not.

Among Medicare beneficiaries at end of life, patients using parenteral prostacyclin had higher total costs — $144,857 compared with $84,335 — in the 180 days prior to death and a higher proportion of spending on medications (59% vs 34%) than patients without parenteral prostacyclin.

The largest proportion of spending was attributed to medication costs, including both pharmacy and nonpharmacy medications. Among patients being treated with prostacyclin the proportion of total spending on nonpharmacy drugs was 54% for Medicare and 30% for those with commercial insurance.

Researchers said that one of the limitations of the study was that it relied on administrative claims data that did not provide information on disease severity or other clinical factors. Comorbid conditions, which the researchers did not have insight into, could also have impacted the total costs.

Additionally, the researchers said that different sources, payer markets, and time periods could produce different results.