Burke James P, Hunsche Elke, Régulier Etienne, Nagao Mitchell, Buzinec Paul, Drake Iii William
Am J Manag Care. 2015 Jan;21(3 Suppl):s47-58.
This study assessed pulmonary hypertension (PH)-related hospitalizations, including readmissions, among US patients with pulmonary arterial hypertension (PAH), a rare disease characterized by high morbidity and premature mortality.
Analysis of claims data (January 1, 2007-April 30, 2011) from adult enrollees with commercial or Medicare Advantage with Part D coverage from a large US health plan.
Patients with PAH were identified based on ≥ 1 medical claim with a PH-related diagnostic code (International Classification of Diseases, Ninth Edition, Clinical Modification code 416.0 for primary pulmonary hypertension or 416.8 for other chronic pulmonary heart disease) and ≥ 1 pharmacy claim for a medication indicated for PAH or frequently used in PAH. Data were analyzed for patients with ≥ 1 hospitalization with a primary or secondary diagnostic code of PH. PH-related hospitalizations were defined as those with ≥ 1 PH-related diagnostic code. The principal diagnosis was defined as the diagnosis most frequently in the first-listed position on a hospitalization's facility claims. Total hospitalization costs (inflated to 2011 US$) and length of stay (LOS) were analyzed. A subgroup analysis evaluated readmissions.
Of 4009 enrollees meeting inclusion criteria, 2275 had ≥ 1 PH-related hospitalization during follow-up: 56.9% were female, 59.4% were < 65 years old, and 67.8% had commercial insurance. Mean (SD) costs across all hospitalizations were $46,118 ($135,137) for commercially insured and $16,319 ($30,046) for Medicare Advantage enrollees; LOS was 10.9 (20.4) and 12.8 (21.2) days, respectively. Costs and LOS were higher for admissions with a principal diagnosis of PH compared with other principal diagnoses: $61,922 ($213,596) versus $42,455 ($108,925) and 14.2 (32.3) versus 10.2 (16.4) days, respectively, for the commercially insured, and $19,584 ($29,501) versus $15,904 ($30,097) and 16.7 (25.7) versus 12.3 (20.5) days, respectively, for Medicare Advantage enrollees. Of the 954 patients who experienced ≥ 1 PH-related readmission within the first year after discharge from the initial hospitalization, 483 (50.6%), 246 (25.8%), and 225 (23.6%) patients had 1, 2, and ≥ 3 readmissions, respectively.
PH-related hospitalizations incur substantial healthcare costs and require long hospital stays for patients with PAH; many are readmitted within 1 year. Improved treatment approaches are needed to reduce PAH disease progression leading to costly and burdensome inpatient stays.
本研究评估了美国肺动脉高压（PAH）患者中与肺动脉高压相关的住院情况，包括再入院情况。PAH是一种罕见疾病，具有高发病率和过早死亡率的特点。
对来自美国一家大型健康计划的、参加商业保险或享有医疗保险优势计划（Medicare Advantage）且包含D部分保险的成年参保者的理赔数据（2007年1月1日至2011年4月30日）进行分析。
根据至少1份带有与肺动脉高压相关诊断代码的医疗理赔记录（《国际疾病分类》第九版临床修订本中，原发性肺动脉高压的代码为416.0，其他慢性肺源性心脏病的代码为416.8）以及至少1份用于PAH或常用于PAH的药物的药房理赔记录来确定PAH患者。对有至少1次住院且主要或次要诊断代码为肺动脉高压的患者的数据进行分析。与肺动脉高压相关的住院定义为带有至少1个与肺动脉高压相关诊断代码的住院。主要诊断定义为住院机构理赔记录中首次列出位置上最常出现的诊断。分析了总住院费用（折算为2011年美元）和住院时长（LOS）。亚组分析评估了再入院情况。
在4009名符合纳入标准的参保者中，2275人在随访期间有至少1次与肺动脉高压相关的住院：56.9%为女性，59.4%年龄小于65岁，67.8%拥有商业保险。商业保险参保者所有住院的平均（标准差）费用为46,118美元（135,137美元），医疗保险优势计划参保者为16,319美元（30,046美元）；住院时长分别为10.9天（20.4天）和12.8天（21.2天）。与其他主要诊断相比，主要诊断为肺动脉高压的入院费用和住院时长更高：商业保险参保者分别为61,922美元（213,596美元）和42,455美元（108,925美元），以及14.2天（32.3天）和10.2天（16.4天）；医疗保险优势计划参保者分别为19,584美元（29,501美元）和15,904美元（30,097美元），以及16.7天（25.7天）和12.3天（20.5天）。在首次住院出院后1年内经历至少1次与肺动脉高压相关再入院的954名患者中，分别有483名（50.6%）、246名（25.8%）和225名（23.6%）患者有1次、2次和3次及以上再入院。
与肺动脉高压相关的住院给PAH患者带来了巨大的医疗费用，且需要较长的住院时间；许多患者在1年内再次入院。需要改进治疗方法以减少PAH疾病进展，从而避免导致昂贵且负担沉重的住院治疗。
