Early intervention in the management of pulmonary arterial hypertension: Clinical and economic outcomes

Charles Dwayne Burger, Mohamedanwar Ghandour, Divya Padmanabhan Menon, Haytham Helmi, Raymond L. Benza

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

Pulmonary arterial hypertension (PAH) has a high morbidity rate and is fatal if left untreated. Increasing evidence supports early intervention, possibly with initial combination therapy. PAH-specific pharmaceuticals, however, are expensive and may have serious adverse effects, particularly when used in combination. The currently dynamic health care economy reinforces the need for a review of early intervention from both outcomes and economic perspectives. We aimed to review the clinical and economic impact of PAH therapy, particularly examining drug cost, hospitalization burden, and health care economics impact, and the effect of early intervention on clinical outcomes. We searched PubMed, Scopus, Ovid, and MEDLINE databases from 2005 to 2017 for studies comparing drug cost, clinical outcomes, and hospitalization burden associated with therapy for PAH. Emerging data indicate that early therapy is effective, but drug therapy is expensive, particularly with combination therapy. Efficacy studies also generally show benefit of combination therapy for patients in World Health Organization functional class II, with a consistent decrease in hospitalization. Pharmacoeconomic studies are limited but indicate that increased pharmacy costs are at least partially offset by decreased health care utilization, particularly inpatient care. Modeling also shows a cost benefit with combination therapy at 2 years. Nonetheless, more rigorously collected health care economic data should be incorporated into future drug efficacy trials to provide a clearer understanding of the impact and the associated cost benefit of early PAH therapy. Increasing evidence in support of early intervention and combination therapy for PAH is associated with rising medication costs that are largely offset by reduced hospitalization, on the basis of the currently available literature. Nonetheless, the studies performed to date have methodologic limitations that highlight the need for prospective studies using more robust economic modeling.

Original languageEnglish (US)
Pages (from-to)731-739
Number of pages9
JournalClinicoEconomics and Outcomes Research
Volume9
DOIs
StatePublished - Nov 24 2017

Fingerprint

Pulmonary Hypertension
Economics
Hospitalization
Drug Costs
Therapeutics
Delivery of Health Care
Cost-Benefit Analysis
Patient Acceptance of Health Care
Costs and Cost Analysis
Pharmaceutical Economics
Early intervention
Hypertension
Therapy
Secondary Prevention
PubMed
MEDLINE
Pharmaceutical Preparations
Inpatients
Databases
Prospective Studies

Keywords

  • Combination therapy
  • Health care costs
  • Hospitalization
  • Pulmonary arterial hypertension

ASJC Scopus subject areas

  • Economics, Econometrics and Finance (miscellaneous)
  • Health Policy

Cite this

Early intervention in the management of pulmonary arterial hypertension : Clinical and economic outcomes. / Burger, Charles Dwayne; Ghandour, Mohamedanwar; Menon, Divya Padmanabhan; Helmi, Haytham; Benza, Raymond L.

In: ClinicoEconomics and Outcomes Research, Vol. 9, 24.11.2017, p. 731-739.

Research output: Contribution to journalReview article

Burger, Charles Dwayne ; Ghandour, Mohamedanwar ; Menon, Divya Padmanabhan ; Helmi, Haytham ; Benza, Raymond L. / Early intervention in the management of pulmonary arterial hypertension : Clinical and economic outcomes. In: ClinicoEconomics and Outcomes Research. 2017 ; Vol. 9. pp. 731-739.
@article{e64d5139420c40bdbb981a331bf48953,
title = "Early intervention in the management of pulmonary arterial hypertension: Clinical and economic outcomes",
abstract = "Pulmonary arterial hypertension (PAH) has a high morbidity rate and is fatal if left untreated. Increasing evidence supports early intervention, possibly with initial combination therapy. PAH-specific pharmaceuticals, however, are expensive and may have serious adverse effects, particularly when used in combination. The currently dynamic health care economy reinforces the need for a review of early intervention from both outcomes and economic perspectives. We aimed to review the clinical and economic impact of PAH therapy, particularly examining drug cost, hospitalization burden, and health care economics impact, and the effect of early intervention on clinical outcomes. We searched PubMed, Scopus, Ovid, and MEDLINE databases from 2005 to 2017 for studies comparing drug cost, clinical outcomes, and hospitalization burden associated with therapy for PAH. Emerging data indicate that early therapy is effective, but drug therapy is expensive, particularly with combination therapy. Efficacy studies also generally show benefit of combination therapy for patients in World Health Organization functional class II, with a consistent decrease in hospitalization. Pharmacoeconomic studies are limited but indicate that increased pharmacy costs are at least partially offset by decreased health care utilization, particularly inpatient care. Modeling also shows a cost benefit with combination therapy at 2 years. Nonetheless, more rigorously collected health care economic data should be incorporated into future drug efficacy trials to provide a clearer understanding of the impact and the associated cost benefit of early PAH therapy. Increasing evidence in support of early intervention and combination therapy for PAH is associated with rising medication costs that are largely offset by reduced hospitalization, on the basis of the currently available literature. Nonetheless, the studies performed to date have methodologic limitations that highlight the need for prospective studies using more robust economic modeling.",
keywords = "Combination therapy, Health care costs, Hospitalization, Pulmonary arterial hypertension",
author = "Burger, {Charles Dwayne} and Mohamedanwar Ghandour and Menon, {Divya Padmanabhan} and Haytham Helmi and Benza, {Raymond L.}",
year = "2017",
month = "11",
day = "24",
doi = "10.2147/CEOR.S119117",
language = "English (US)",
volume = "9",
pages = "731--739",
journal = "ClinicoEconomics and Outcomes Research",
issn = "1178-6981",
publisher = "Dove Medical Press Limited",

}

TY - JOUR

T1 - Early intervention in the management of pulmonary arterial hypertension

T2 - Clinical and economic outcomes

AU - Burger, Charles Dwayne

AU - Ghandour, Mohamedanwar

AU - Menon, Divya Padmanabhan

AU - Helmi, Haytham

AU - Benza, Raymond L.

PY - 2017/11/24

Y1 - 2017/11/24

N2 - Pulmonary arterial hypertension (PAH) has a high morbidity rate and is fatal if left untreated. Increasing evidence supports early intervention, possibly with initial combination therapy. PAH-specific pharmaceuticals, however, are expensive and may have serious adverse effects, particularly when used in combination. The currently dynamic health care economy reinforces the need for a review of early intervention from both outcomes and economic perspectives. We aimed to review the clinical and economic impact of PAH therapy, particularly examining drug cost, hospitalization burden, and health care economics impact, and the effect of early intervention on clinical outcomes. We searched PubMed, Scopus, Ovid, and MEDLINE databases from 2005 to 2017 for studies comparing drug cost, clinical outcomes, and hospitalization burden associated with therapy for PAH. Emerging data indicate that early therapy is effective, but drug therapy is expensive, particularly with combination therapy. Efficacy studies also generally show benefit of combination therapy for patients in World Health Organization functional class II, with a consistent decrease in hospitalization. Pharmacoeconomic studies are limited but indicate that increased pharmacy costs are at least partially offset by decreased health care utilization, particularly inpatient care. Modeling also shows a cost benefit with combination therapy at 2 years. Nonetheless, more rigorously collected health care economic data should be incorporated into future drug efficacy trials to provide a clearer understanding of the impact and the associated cost benefit of early PAH therapy. Increasing evidence in support of early intervention and combination therapy for PAH is associated with rising medication costs that are largely offset by reduced hospitalization, on the basis of the currently available literature. Nonetheless, the studies performed to date have methodologic limitations that highlight the need for prospective studies using more robust economic modeling.

AB - Pulmonary arterial hypertension (PAH) has a high morbidity rate and is fatal if left untreated. Increasing evidence supports early intervention, possibly with initial combination therapy. PAH-specific pharmaceuticals, however, are expensive and may have serious adverse effects, particularly when used in combination. The currently dynamic health care economy reinforces the need for a review of early intervention from both outcomes and economic perspectives. We aimed to review the clinical and economic impact of PAH therapy, particularly examining drug cost, hospitalization burden, and health care economics impact, and the effect of early intervention on clinical outcomes. We searched PubMed, Scopus, Ovid, and MEDLINE databases from 2005 to 2017 for studies comparing drug cost, clinical outcomes, and hospitalization burden associated with therapy for PAH. Emerging data indicate that early therapy is effective, but drug therapy is expensive, particularly with combination therapy. Efficacy studies also generally show benefit of combination therapy for patients in World Health Organization functional class II, with a consistent decrease in hospitalization. Pharmacoeconomic studies are limited but indicate that increased pharmacy costs are at least partially offset by decreased health care utilization, particularly inpatient care. Modeling also shows a cost benefit with combination therapy at 2 years. Nonetheless, more rigorously collected health care economic data should be incorporated into future drug efficacy trials to provide a clearer understanding of the impact and the associated cost benefit of early PAH therapy. Increasing evidence in support of early intervention and combination therapy for PAH is associated with rising medication costs that are largely offset by reduced hospitalization, on the basis of the currently available literature. Nonetheless, the studies performed to date have methodologic limitations that highlight the need for prospective studies using more robust economic modeling.

KW - Combination therapy

KW - Health care costs

KW - Hospitalization

KW - Pulmonary arterial hypertension

UR - http://www.scopus.com/inward/record.url?scp=85036550523&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85036550523&partnerID=8YFLogxK

U2 - 10.2147/CEOR.S119117

DO - 10.2147/CEOR.S119117

M3 - Review article

AN - SCOPUS:85036550523

VL - 9

SP - 731

EP - 739

JO - ClinicoEconomics and Outcomes Research

JF - ClinicoEconomics and Outcomes Research

SN - 1178-6981

ER -