Didden Eva-Maria, Lee Eileen, Wyckmans Julie, Quinn Deborah, Perchenet Loïc
Actelion Pharmaceuticals Ltd Allschwil Switzerland.
Janssen Research & Development Spring House Pennsylvania USA.
Pulm Circ. 2023 Jan 1;13(1):e12188. doi: 10.1002/pul2.12188. eCollection 2023 Jan.
The main aim of this analysis was to investigate time from symptom onset (chronic unexplained dyspnoea [CUD]) to diagnosis of Group 1 pulmonary hypertension (PH)-pulmonary arterial hypertension (PAH)-and to characterize healthcare resource utilization leading up to diagnosis using a nationwide US claims and an electronic health record (EHR) database from Optum. Eligible patients were ≥18 years old at first CUD diagnosis (index event) and had a PAH diagnosis on or after index date. Based on administrative codes, PAH was defined as right heart catheterization (RHC), ≥ 2 PAH diagnoses (1 within a year of RHC), and ≥1 post-RHC prescription for PAH treatment. All values are median (1st quartile-3rd quartile) unless otherwise stated. Of 854,722 patients with CUD in the claims database, 582 (0.1%) had PAH. Time from CUD to PAH diagnosis was 2.26 (0.73-4.22) years. PAH patients experienced 3 (2-4) transthoracic echocardiograms (TTEs), 6 (3-12) specialist visits, and 2 (1-4) hospitalizations during the diagnostic interval. Almost one-third of patients (29%) waited 10 months or more to have a TTE. Findings from the EHR database were broadly similar. Resource utilization during the diagnostic interval was also analyzed in an overall PH cohort: findings were generally similar to the PAH cohort (2 [1-3] TTEs, 4 [2-9] specialist visits and 2 [1-4] hospitalizations). These data indicate a delay in the diagnostic pathway for PAH, and illustrate the burden associated with PAH diagnosis.
本分析的主要目的是调查从症状发作（慢性不明原因呼吸困难[CUD]）到1组肺动脉高压（PH）-肺动脉高压（PAH）诊断的时间，并利用美国全国性索赔数据和来自Optum的电子健康记录（EHR）数据库，对诊断前的医疗资源利用情况进行描述。符合条件的患者在首次CUD诊断（索引事件）时年龄≥18岁，且在索引日期或之后被诊断为PAH。根据管理代码，PAH被定义为右心导管检查（RHC）、≥2次PAH诊断（RHC后1年内1次）以及≥1次RHC后PAH治疗处方。除非另有说明，所有值均为中位数（第1四分位数-第3四分位数）。在索赔数据库中的854,722例CUD患者中，582例（0.1%）患有PAH。从CUD到PAH诊断的时间为2.26（0.73-4.22）年。PAH患者在诊断期间接受了3（2-4）次经胸超声心动图（TTE）检查、6（3-12）次专科就诊以及2（1-4）次住院治疗。几乎三分之一的患者（29%）等待10个月或更长时间才进行TTE检查。EHR数据库的结果大致相似。还对整个PH队列的诊断期间的资源利用情况进行了分析：结果与PAH队列总体相似（2[1-3]次TTE检查、4[2-9]次专科就诊和2[1-4]次住院治疗）。这些数据表明PAH诊断途径存在延迟，并说明了与PAH诊断相关的负担。
