Characterizing Pulmonary Hypertension-Related Hospitalization Costs Among Medicare Advantage or Commercially Insured Patients With Pulmonary Arterial Hypertension: A Retrospective Database Study

Objectives: 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. Study Design: 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. Methods: 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. Results: 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. Conclusions: 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.