Burden of illness in patients with pulmonary hypertension due to interstitial lung disease: a real-world analysis

Abstract Background Pulmonary hypertension due to interstitial lung disease (PH-ILD) is associated with high rates of respiratory failure and death. Healthcare resource utilization (HCRU) and cost data are needed to characterize PH-ILD disease burden. Methods A retrospective cohort analysis of the Truven Health MarketScan ® Commercial Claims and Encounters Database and Medicare Supplemental Database between June 2015 to June 2019 was conducted. Patients with ILD were identified and indexed based on their first claim with a PH diagnosis. Patients were required to be 18 years of age on the index date and continuously enrolled for 12-months pre- and post-index. Patients were excluded for having a PH diagnosis prior to ILD diagnosis or the presence of other non-ILD, PH-associated conditions. Treatment patterns, HCRU, and healthcare costs were compared between the 12 months pre- versus 12 months post-index date. Results In total, 122 patients with PH-ILD were included (mean SD age, 63. 7 16. 6 years; female, 64. 8%). The same medication classes were most frequently used both pre- and post-index (corticosteroids: pre-index 43. 4%, post-index 53. 5%; calcium channel blockers: 25. 4%, 36. 9%; oxygen: 12. 3%, 25. 4%). All-cause hospitalizations increased 2-fold, with 29. 5% of patients hospitalized pre-index vs. 59. 0% post-index (P < 0. 0001). Intensive care unit (ICU) utilization increased from 6. 6 to 17. 2% (P = 0. 0433). Mean inpatient visits increased from 0. 5 (SD, 0. 9) to 1. 1 (1. 3) (P < 0. 0001) ; length of stay (days) increased from 5. 4 (5. 9) to 7. 5 (11. 6) (P < 0. 0001) ; bed days from 2. 5 (6. 6) to 8. 0 (16. 3) (P < 0. 0001) ; ICU days from 3. 8 (2. 3) to 7. 0 (13. 2) (P = 0. 0362) ; and outpatient visits from 24. 5 (16. 8) to 32. 9 (21. 8) (P < 0. 0001). Mean (SD) total all-cause healthcare costs increased from 43, 201 (98, 604) pre-index to 108, 387 (190, 673) post-index (P < 0. 0001) ; this was largely driven by hospitalizations (which increased from a mean SD of 13, 133 28, 752 to 63, 218 75, 639 P < 0. 0001) and outpatient costs (16, 150 75, 639 to 25, 604 93, 964 P < 0. 0001). Conclusion PH-ILD contributes to a high HCRU and cost burden. Timely identification, management, and treatment are needed to mitigate the clinical and economic consequences of PH-ILD development and progression.