Tsang Yuen, Panjabi Sumeet, Funtanilla Vienica, Germack Hayley D, Gauthier-Loiselle Marjolaine, Manceur Ameur M, Liu Stephanie, Cloutier Martin, Lefebvre Patrick
Real-World Value & Evidence Janssen Scientific Affairs, LLC Titusville New Jersey USA.
Analysis Group, Inc. Montréal Québec Canada.
Pulm Circ. 2023 Apr 1;13(2):e12218. doi: 10.1002/pul2.12218. eCollection 2023 Apr.
Pulmonary arterial hypertension (PAH) is commonly associated with connective tissue disorders (CTDs). This study provides a contemporary assessment of the economic burden of CTD + PAH and PAH in the United States. Eligible adult patients identified from Optum's deidentified Clinformatics® Data Mart Database (10/01/2015-09/30/2021) were classified into mutually exclusive cohorts based on recorded diagnoses: (1) CTD + PAH, (2) PAH, (3) CTD, (4) control without CTD/PAH. The index date was a randomly selected diagnosis date for PAH (CTD + PAH, PAH cohorts) or CTD (CTD cohort), or a random date (control cohort). Entropy balancing was used to balance characteristics across cohorts. Healthcare costs and healthcare resource utilization (HRU) per patient per month (PPPM) were assessed for ≤12 months postindex and compared among balanced cohorts. A total of 552,900 patients were included (CTD + PAH: = 1876; PAH: = 8177; CTD: = 209,156; control: = 333,691). Average total all-cause costs were higher for CTD + PAH than PAH cohort ($16,854 vs. $15,686 PPPM; = 0.02); both cohorts incurred higher costs than CTD and control cohorts ($4476 and $2170 PPPM; all < 0.001). Average HRU PPPM was similar between CTD + PAH and PAH cohorts (inpatient stay: 0.15 vs. 0.15, outpatient visits: 4.23 vs. 4.11; all > 0.05), while CTD and control cohorts incurred less HRU (inpatient stay: 0.07 and 0.03, outpatient visits: 2.67 and 1.69; all < 0.001). CTD + PAH and PAH are associated with a substantial economic burden. The incremental burden attributable to PAH versus the general population and patients with CTD without PAH highlights significant unmet needs among PAH patients.
肺动脉高压（PAH）通常与结缔组织病（CTD）相关。本研究对美国CTD合并PAH和PAH的经济负担进行了当代评估。从Optum的去识别化临床信息学数据集市数据库（2015年10月1日至2021年9月30日）中识别出的符合条件的成年患者，根据记录的诊断分为相互排斥的队列：（1）CTD合并PAH，（2）PAH，（3）CTD，（4）无CTD/PAH的对照。索引日期是PAH（CTD合并PAH、PAH队列）或CTD（CTD队列）的随机选择诊断日期，或随机日期（对照队列）。使用熵平衡来平衡各队列的特征。对索引后≤12个月的每位患者每月的医疗费用和医疗资源利用（HRU）进行评估，并在平衡后的队列之间进行比较。共纳入552,900名患者（CTD合并PAH：=1876；PAH：=8177；CTD：=209,156；对照：=333,691）。CTD合并PAH队列的平均全因总成本高于PAH队列（每月每患者16,854美元对15,686美元；=0.02）；两个队列的成本均高于CTD和对照队列（每月每患者4476美元和2170美元；所有<0.001）。CTD合并PAH和PAH队列之间的平均HRU每月每患者相似（住院天数：0.15对0.15，门诊就诊次数：4.23对4.11；所有>0.05），而CTD和对照队列的HRU较少（住院天数：0.07和0.03，门诊就诊次数：2.67和1.69；所有<0.001）。CTD合并PAH和PAH与巨大的经济负担相关。PAH相对于一般人群和无PAH的CTD患者的增量负担突出了PAH患者中显著未满足的需求。
