Pulmonary Hypertension Diagnosis on Top of ILD Subsequently Increases Healthcare Use, Costs

Patients with interstitial lung disease who are subsequently diagnosed with pulmonary hypertension experience a significant increase in healthcare resource utilization and costs.

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Real-world healthcare resource utilization (HCRU) and costs increase substantially for patients with interstitial lung disease (ILD) who are subsequently diagnosed with pulmonary hypertension (PH), according to research comparing patient data in the 12 months before and after a PH-ILD diagnosis. The findings were published in BMC Pulmonary Medicine.

There are more than 200 types of ILD, and many times a doctor cannot find a reason for the disease, according to the Pulmonary Fibrosis Foundation. In these cases, the most common type of idiopathic ILD is idiopathic pulmonary fibrosis (IPF). More than 250,000 Americans have ILD and pulmonary fibrosis, which is a scarring of the lungs in many types of ILD.

Scarring to the lungs in patients with ILD impacts their ability to breathe and over the long term, the disease causes respiratory and heart failure. At the initial diagnosis of IPF, PH prevalence is 8% to 15%, but this increases to 29% to 46% when patients are being evaluated for a lung transplant, and up to 86% when a transplant takes place.

“Patients with PH-ILD and progressive pulmonary fibrosis can decline rapidly and have particularly high rates of respiratory failure and death,” wrote the authors of the new study.

Currently, there are two drugs approved for IPF— nintedanib and pirfenidone—but neither of them have been studied regarding their effect on PH attributed to IPF, the authors noted. There is one FDA-approved drug for PH-ILD, Treprostinil, which is available in two inhaled forms.

The authors analyzed the Truven Health MarketScan Commercial Claims and Encounters Database and Medicare Supplemental Database between June 2015 to June 2019 in order to better understand treatment patterns, HCRU and health-related costs for patients with ILD before and after a subsequent PH diagnosis.

A total of 9,379 patients were identified has having a claim for ILD and PH, but only 122 per included after the selection criteria. The mean age was 63.7 years and 64.8% were female. Slightly more than half (54.9%) had commercial insurance, and 32.0% lived in the South. Chronic pulmonary disease (94.3%), diabetes (36.1%) and rheumatic disease (34.4%) were the most common comorbidities.

The medications used prior to the PH diagnosis mostly continued to be used after the diagnosis. The most commonly used was corticosteroids (43.4% pre-index and 53.5% post-index), calcium channel blockers (25.4% pre-index and 36.9% post-index) and oxygen (12.3% pre-index and 25.4% post-index).

Prior to PH diagnosis, 29.5% of patients experienced a hospitalization, which increased to 59.0% after the PH diagnosis. In addition, the mean number of inpatient visits, length of stay per hospitalization, hospital bed days and intensive care unit days were all significantly higher after a PH diagnosis compared with before the PH diagnosis. The mean number of outpatient visits was also significantly higher after PH diagnosis.

The authors also found that the mean number of unique prescriptions filled increased significantly from 37.5 a year prior to the PH diagnosis to 46.4 a year after.

Mean total healthcare costs increased significantly from $43,201 to $108,387 driven mostly by increased inpatient costs. Mean hospitalization costs were $13,133 prior to the PH diagnosis and increased to $63,218 after the PH diagnosis. The cost of prescriptions increased 66% from before the diagnosis ($7,913) to after ($13,153).

According to the authors, the data suggests that a subsequent PH diagnosis for patients with ILD substantially increases utilization of healthcare resources as well as costs.

Among the limitations that the authors noted were the retrospective nature of the study since the data were captured for reimbursement purposes and there may be inaccuracies in the diagnostic coding or pharmacy claims. The data may only include patients with insurance, so findings might not be generalizable to uninsured patients.

“…PH is a costly and complex disease,” the authors concluded. “However, patients with ILD appear to experience a uniquely high medical and healthcare cost burden after diagnosis of pulmonary hypertension. The timely management and treatment of PH-ILD is needed to mitigate the clinical and economic consequences of disease progression.”