• Noam Y Kirson, Howard G Birnbaum, Jasmina I Ivanova, Tracy Waldman, Vijay Joish, and Todd Williamson.
• Analysis Group, Inc., Boston, MA, USA.
• Appl Health Econ Health Policy. 2011 Nov 1; 9 (6): 377-87.

BackgroundChronic thromboembolic pulmonary hypertension (CTEPH) is a rare and potentially fatal disease. Little is known about the economic burden associated with CTEPH patients in the US.ObjectivesThe objective of this study was to estimate excess direct costs associated with privately insured patients with CTEPH in the US.MethodsFrom a privately insured claims database (>8 million beneficiaries, 2002-7), 289 CTEPH patients were identified using the criteria: two or more claims for pulmonary hypertension (PH), International Classification of Diseases, ninth edition, clinical modification (ICD-9-CM) code 416.0 or 416.8; one or more claim for pulmonary embolism (ICD-9-CM: 415.1, V12.51; ICD-9 procedure: 38.7; Current Procedural Terminology [CPT]-4 code: 36010, 37620, 75825, 75940; Healthcare Common Procedure Coding System [HCPCS] code: C1880) within 12 months prior or 1 month after the initial PH claim (index date); one or more claim for right heart catheterization (RHC) within 6 months prior to any PH claim or one or more claim for echocardiogram within 6 months prior to a specialist-diagnosed PH claim; aged 18-64 years. Patients with CTEPH were matched demographically to controls without PH. Patients were followed as long as continuously eligible; mean follow-up in CTEPH patients was 21.5 months. Chi-squared tests were used to compare baseline co-morbidities. Wilcoxon rank-sum tests were used to compare direct (medical and pharmaceutical) patient-month costs to insurers.ResultsThe average age for CTEPH patients was 52.2 years, and 57.1% were women. Compared with controls, CTEPH patients had significantly higher baseline rates of co-morbidities (e.g. essential hypertension, congestive heart failure and chronic pulmonary disease) and a higher mean Charlson Co-morbidity Index score. Mean direct patient-month costs (year 2007 values) were $US4782 for CTEPH patients and $US511 for controls (p < 0.0001). Sensitivity analysis restricting the sample to patients diagnosed following RHC yielded a 15% increase in excess costs relative to the original sample. Regarding cost drivers, inpatient services accounted for 54%, outpatient and other services for 33% and prescription drugs for 11% of total direct healthcare costs per patient-month in CTEPH patients. Circulatory-/respiratory-related patient-month costs were $US2496 among CTEPH patients and $US128 among controls (p < 0.0001).ConclusionsCTEPH patients had substantially higher costs and co-morbidity than matched controls, with circulatory-/respiratory-related costs accounting for 55% of excess costs. The high burden of illness suggests opportunities for savings from improved management.

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