Changes in healthcare utilization and costs associated with sildenafil therapy for pulmonary arterial hypertension: a retrospective cohort study

Using a large US health insurance claims database, we identified all patients with evidence of PAH (ICD-9-CM diagnosis codes 416.0, 416.8) who received sildenafil between 1/1/2005 and 9/30/2008. Date of the first-noted prescription for sildenafil was designated the “index date,” and claims data were compiled for all study subjects for 6 months prior to their index date (“pretreatment”) and 6 months thereafter (“follow-up”); patients with incomplete data during either of these periods were excluded. Healthcare utilization and costs were then compared between pretreatment and follow-up for all study subjects.A total of 567 PAH patients were identified who began therapy with sildenafil and met all other study entry criteria. Mean (SD) age was 52 (10) years; 73% were women. Healthcare utilization was largely unchanged between pretreatment and follow-up, the only exceptions being decreases in the mean number of emergency department visits (from 0.7 to 0.5 per patient; p？<？0.01) and the percentage of patients hospitalized (from 35% to 29%; p？=？0.01). The mean cost of all PAH-related medication was $7139 during pretreatment and $14,095 during follow-up (sildenafil cost during follow-up？=？$5236); exclusive of PAH-related medications, however, total healthcare costs decreased modestly (from $30,104 to $27,605) (p？<？0.01 for all comparisons).The cost of sildenafil therapy may be partially offset by reductions in other healthcare costs.Pulmonary arterial hypertension (PAH) is characterized by a pathological narrowing of the pulmonary arterioles and small arteries, which causes elevated pulmonary vascular resistance and increased pressure in the pulmonary arteries and eventually results in the development of right ventricular failure and death [1,2]. Dyspnea, fatigue, chest pain, and syncope are the principal presenting symptoms of PAH [3]. The disease is one form of pulmonary hypertension (broadly defined as increased pressure in the pulmonary arteries, capillaries, or veins).