Healthcare burden of pulmonary hypertension owing to lung disease and/or hypoxia.

BACKGROUND: Group 3 pulmonary hypertension (PH) encompasses PH owing to lung diseases and/or hypoxia. Treatment patterns, healthcare resource use, and economic burden to US payers of Group 3 PH patients were assessed. METHODS: This retrospective observational study extracted data from July 1, 2010 to June 30, 2013 from two Truven Health Analytics MarketScan databases. Adult Group 3 PH patients were identified based on claims for PH (ICD-9-CM 416.0/416.8), a related lung disease, and an echocardiogram or right heart catheterization (RHC). The index date was the date of the first PH claim; data were collected for 12 months pre- and post-index. A difference-in-difference approach using generalized estimating equations was done to account for baseline differences. RESULTS: Group 3 PH patients (n = 2,236) were matched 1:1 to controls on lung disease. PH patients had higher all-cause resource utilization and annual healthcare costs ($44,732 vs. $7,051) than controls. Costs were driven by inpatient admissions (35.4% of total costs), prescriptions (33.0%), and outpatient care (26.5%). Respiratory-related costs accounted for 11.4% of post-index annual costs for PH patients. PH diagnosis was not confirmed in the majority of PH patients (<7% RHC use) but nevertheless, 22% of PH patients post-index had claims for drugs approved for the treatment of pulmonary arterial hypertension (PAH). CONCLUSIONS: Group 3 PH poses a significant clinical and economic burden. Given the low use of RHC and the prevalence of PAH-indicated prescriptions that are not currently approved for Group 3 PH, this study suggests some Group 3 PH patients may not be receiving guideline-recommended treatment.

Evaluating the efficiency of treatment in the allergic rhinitis market.

BACKGROUND: In the present era of increasing health care expenditures, economic comparisons of therapeutic products play an important role in ensuring that limited health care resources are used appropriately. OBJECTIVE: To provide a model for the comparative analysis of alternative treatments, in terms of both cost and efficacy, in allergic rhinitis that will provide decision makers in a managed care environment an additional tool to help maximize health care benefit per dollar spent. We also review current treatments in the allergic rhinitis market and their impact on cost, availability, and utilization. SUMMARY: Efficacy estimates were derived from published reviews, meta-analyses, and guidelines, and cost data are based on average wholesale prices. Our results indicate that when cost and efficacy data are plotted on a cost-effectiveness plane, the intranasal corticosteroids appear to be the most efficient use of health care resources. Moreover, budesonide aqueous nasal spray was found to be the most efficient treatment for allergic rhinitis when compared with 3 other leading intranasal corticosteroids used at their recommended starting doses, the less-sedating/nonsedating antihistamines, and a leukotriene receptor antagonist. CONCLUSION: Evaluating products on an efficiency frontier platform, which integrates both the effectiveness and cost of products, will allow health plan decision makers to ensure the appropriate allocation of health care resources.