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Health Care Costs and Resource Utilization Prior to Initiation of a Prostacyclin Receptor Agonist for Pulmonary Arterial Hypertension in a Real-World Database Representing a Large US Health Plan

Janis Pruett

Michael Hull

Charles Elliott

Yuen Tsang

William Drake


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Conference: 2018 PHA International PH Conference & Scientific Sessions

Release Date: 06.28.2018

Presentation Type: Abstracts

File Download: Conference 2018_1023

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2018 International PH Conference and Scientific SeAbstract presented at the 2018 International PH Conference and Scientific Sessions in Orlando, Fla., June 28-July 1, 2018.


This study examined the health care resource utilization (HCRU) and costs among patients with PAH in the year prior to the addition of selexipag, an oral selective IP prostacyclin receptor agonist agent, to the treatment regimen.


Pulmonary arterial hypertension (PAH) is a chronic and progressive disease characterized by abnormally high pressure in the pulmonary arterioles, with increased pulmonary vascular resistance that may result in right heart failure and premature death. Studies have demonstrated that medications that act on the prostacyclin pathway are effective therapies for PAH. As new PAH specific medications targeting the prostacyclin pathway are introduced, treatment patterns and HCRU must be considered by providers and payers. The real-world treatment patterns of selexipag, an oral selective IP prostacyclin receptor agonist agent, remain largely unexplored.


Patients with a diagnosis code for pulmonary hypertension and a prescription fill for selexipag identified by pharmacy claims between January 2016 and May 2017 were included. Patients were ≥18 years old with continuous enrollment in a large US health plan with medical and pharmacy coverage for 1 year (baseline period) before initiation of selexipag. Diagnosis, pharmacy, and medical codes were used to identify baseline comorbidities and medications. HCRU and costs were examined during the baseline period and the 6 months after selexipag initiation.


The study included 95 patients, mostly female (70.5%) with mean(+SD) age 61.8±13.8 years, Charlson score 3.6±2.3, and 67.4% enrolled in Medicare Advantage plans. Common comorbidities included hypertension (81.1%), heart failure (64.2%), sleep apnea (41.1%), and type 2 diabetes mellitus (26.3%). Baseline inpatient admissions occurred in 41.9% and 51.6% of commercial and MAPD enrollees, respectively. Mean all-cause baseline medical costs were $46,024 for commercial enrollees and $57,581 for MAPD enrollees, and increased 266.8% and 26.7%, respectively, from the first to the last quarter prior to selexipag initiation. In 42 patients with six months of follow-up after initiation of selexipag, mean all-cause medical costs were $17,215 and $23,976 for commercial and MAPD enrollees, respectively.


Patients with PAH presented with complex comorbidity profiles, and a high percentage were admitted for inpatient stays in the year prior to initiation of selexipag. In the six months prior to selexipag initiation, mean all-cause baseline medical costs substantially increased over time, particularly among commercial enrollees. For 44% of enrolled patients, mean all-cause medical costs six months after selexipag initiation were available and showed an all-cause medical costs decrease of 62% and 58% for commercial and MAPD enrollees, respectively.