Guideline Based Estimates of Diagnostic and Treatment-Related Resource Use and Costs of a Typical Pulmonary Arterial Hypertension Patient to U.S. Health Plan

Abstract

PURPOSE: To outline the resource use and costs a U.S. health plan can anticipate during the evaluation and first year of treatment of a PAH patient. METHODS: An interactive economic model was developed based on the 2009 diagnostic and treatment guidelines for pulmonary hypertension published by the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association. Model assumptions were as follows: a) patient and physician are 100% adherent to diagnostics and treatments; b) patient undergoes all diagnostic tests before being diagnosed within a 12-month period; c) patient has stable disease over the 12-month treatment period; d) first intra-venous infusion/subcutaneous drug is administered by a provider and the subsequent at home and e) guideline recommended disease management costs were included however cost of pharmacotherapy monitoring and adverse events were not included. The model allowed for estimating the resource and cost of treatment for three types of PAH patient based on vaso-reactive test: positive, negativelow risk, negative-high risk. Unit costs for each resource use were derived from publically available sources that included MediSpan's master drug database, Medicare 2013 physician fee schedule, and Medicare clinical diagnostic laboratory fee schedule. RESULTS: Diagnostic costs were $6,378.78 per PAH patient based on ACCF guidelines. Annual pharmacotherapy costs were $2,456.66 for positive, $1,206.24 for negative-low risk, and $30,174.31 for negative-high risk patients. Annual disease management costs were highest for a high risk patient ($7,529.58) while costs were similar for a low-risk and a vaso-reactive positive patient ($3,436.81). CONCLUSIONS: This is the first study that outlines the anticipated resource use and cost of a single PAH patient from a U.S. health plan perspective.