BACKGROUND: Prostacyclin class therapy plays an important role for patients with pulmonary arterial hypertension (PAH). Treprostinil (TRE) offers three routes of administration for PAH patients, but its place in therapeutic strategies varies depending on disease severity. There is limited data on real-world management of PAH leading up to the initiation of TRE.
OBJECTIVE: To characterize clinical and economic outcomes prior to the initiation of TRE for PAH patients.
METHODS: A retrospective cohort study was conducted using the US-based IQVIA PharMetrics Plus® claims database. Patients initiating TRE between 01-Oct-2013 and 30-Sep-2018 were identified. Patients were indexed to the date of their earliest claim with a PH diagnosis or PAH-specific therapy, up to 10 years prior (01-Oct-2008). Patients were required to be ≥18 years of age at index (earliest claim), have ≥1 diagnosis for PH before or within 7 days of TRE initiation, no prior PH diagnosis or PAH-specific therapy in the 4-months prior to index, and had to be continuously enrolled in the database from 4-months prior to index through the initiation of TRE. Cohorts were delineated by route of administration of first observed TRE claim: parenteral[PAR], inhaled[INH], or oral[PO]. Demographics and clinical characteristics are described prior to index; per-person per-month (PPPM) healthcare resource utilization and costs between index date to initiation of TRE are shown with descriptive statistics.
RESULTS: A total of 409 patients that initiated TRE and met selection criteria were identified. Of these, 125, 218 and 66 patients received TRE via PAR, INH and PO routes, respectively. Most patients were female (range: 67%-73%). Patients initiating PAR were younger, with a mean age (standard deviation[SD]) of 47.4(12.9) years, relative to 57.0(11.2) years for the INH and 51.8(13.6) years for the PO cohorts. Mean(SD) all-cause PPPM hospitalizations prior to initiation of TRE was 0.8(1.5) for PAR, 0.2(0.4) for INH, and 0.2(0.5) for PO patients. Mean(SD) all-cause PPPM costs prior to initiation of TRE were $33,675(50,711) for PAR, $11,664(16,082) for INH, and $16,507(31,140) for PO initiators. Similarly, prior to initiation of TRE, PPPM PAH-related healthcare resource utilization and costs were highest for PAR initiators.
CONCLUSIONS: Patients initiating parenteral treprostinil tended to be younger and had the highest utilization of healthcare resources and costs prior to initiation, compared to patients initiating inhaled or oral treprostinil. Further research should focus on timely identification of PAH and earlier initiation of parenteral prostacyclin class therapy.
