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Purpose: The financial burden associated with providing healthcare to patients with pulmonary hypertension (PH) is not well characterized. We sought to quantify three-year healthcare expenditures and determine whether expenditures differed between incident and prevalent PH cases.
Methods: This was a retrospective cohort study involving Kaiser Permanente Colorado (KPCO) patients with a confirmed diagnosis of PH. Included patients were followed from study entry until three years, death or termination of KPCO membership. All expenditures were reported in 2011 US dollars from KPCO perspective.
Results: In total, 157 patients were included: 44 (28%) prevalent and 113 (78%) incident cases. Mean age (prevalent vs. incident cases) was 61 years vs. 67 years and 13.6% vs. 27.4% were men. Mortality was equivalent between prevalent and incident cases (34.1% vs. 25.7%; p=0.291). Significant differences between prevalent and incident cases were noted for median total emergency department (ED) expenditures ($357 vs. $1250; p=0.009) and median total inpatient expenditures ($980 vs. $7,313; p=0.028). Median daily expenditures ($54 vs. $56; p=0.284), median total expenditures ($37,340 vs. $55,073; p=0.284), median pharmacy daily expenditures ($4 vs. $5; p=0.867), median PH specialty medication daily expenditures ($226 vs. $223 among specialty medication users only; p=0.574), and mean days of follow-up (843 vs. 975 days; p=0.331) were equivalent between prevalent and incident cases.
Conclusion: Healthcare expenditures related to the management of PH represent a substantial financial burden. Significant differences according to prevalent or incident case status appeared to be driven by median ED and inpatient costs; however, PH specialty medication expenditures (for those patients receiving them) represented a significant driver of costs overall. Future efforts should focus on optimizing care for patients with PH to avoid unnecessary harm or waste.