Garo Owens, MD, is president of Gary Owens Associates, and here he discusses optimizing treatment goals for patients with pulmonary arterial hypertension (PAH) while reducing care costs.
Gary Owens, MD, is president of Gary Owens Associates, and here he discusses optimizing treatment goals for patients with pulmonary arterial hypertension (PAH) while reducing care costs.
What opportunities are there to incorporate different managed care considerations to help drive down cost and improve treatment goals in PAH?
You are right; it is a pretty expensive disease. I’ll give you a study. It’s getting a little bit dated, and so numbers will probably look a little bit different, but this was published in 2014, and it was a claims-based analysis of over 500 patients with PAH. It was taken from claims in a large US managed care plan, so it’s real-world data. The data were collected between 2004 and 2010 and they looked at health care resource utilization in the 12 months before the diagnosis was actually confirmed and the 12 months after the diagnosis. What they found was, the spending before the diagnosis was mostly medical spending, as you might guess, due to the diagnostic workup, testing, laboratory testing, and specialist visits. The medical cost during that prediagnosis period was close to $98,000 and the pharmacy cost was somewhere in the neighborhood of $6000. Fast forward, the medical costs actually went down to around $59,000, but the pharmacy costs went up to $38,000. So what does that tell us once you’ve made the diagnosis?
A lot of the medical cost has been spent; the pharmacy costs does go up, but it doesn’t offset the medical costs—meaning medical costs, total cost of care, went down for these patients. What this study doesn’t tell us is what the longitudinal cost will be over 2, 3, or 5 years, and I really haven’t seen any good studies on that. What I have seen though, is you if you can avoid hospitalization, you can probably also manage costs better. A lot of the treatments are aimed at avoiding hospitalization, because another study—a bit more recent, published actually in The American Journal of Managed Care®, in 2015—showed the average cost of a patient with PAH and 1 hospitalization was about $50,000, and a readmission for these patients cost over $35,000. Some of these cases went up as high as $100,000 to $150,000 per case.
So, better managing drug therapy, making sure patients do have access to the right therapies, given at the right level, and for the right degree of risk, yes, that will increase pharmacy costs, but it also will decrease—at least based on the data we have, and I hope to see more of those economic analyses—it will hopefully decrease total medical costs going forward. What I’d really like to see, and put that challenge out there, is for somebody to do maybe a 3- to 5-year analysis of cost for these patients and see how that cost trends over time.
I think it’s an area payers, again, need to pay attention to. They need to understand, yes, it’s about managing pharmacy costs, but managing pharmacy costs and potentially decreasing access could actually increase total medical costs, which is not exactly the goal any of us want.