Burden Of Pulmonary Arterial Hypertension In England: Retrospective Hes Database Analysis

Background:The clinical and economic burden of pulmonary arterial hypertension (PAH) is poorly understood outside the United States. This retrospective database study describes the characteristics of patients with PAH in England, including their healthcare resource utilisation (HCRU) and associated costs.Methods:Data from 1 April 2012 to 31 March 2018 were obtained from the National Health Service (NHS) Digital Hospital Episode Statistics database, which provides full coverage of patient events occurring in NHS England hospitals. An adult patient cohort was defined using an algorithm incorporating pulmonary hypertension (PH) diagnosis codes, PAH-associated procedures, PH specialist centre visits and PAH-specific medications. HCRU included inpatient admissions, outpatient visits and Accident and Emergency (A&E) attendances. Associated costs, calculated using national tariffs inflation-adjusted to 2017, did not include PAH-specific drugs on the High Cost Drugs list.Results:The analysis cohort included 2527 patients (68.4% female; 63.6% aged > 50 years). Mean annual HCRU rates ranged from 2.9 to 3.2 for admissions (21-25% of patients had > 5 admissions), 9.4-10.3 for outpatient visits and 0.8-0.9 for A&E attendances. Costs from 2013 to 2017 totalled 43.2M pound (33.9M pound admissions, 8.3M pound outpatient visits and 0.9M pound A&E attendances). From 2013 to 2017, mean cost per patient decreased 13% (from 4400 pound to 3833) pound for admissions and 13% (from 1031 pound to 896) pound for outpatient visits, but increased 52% (from 81 pound to 123) pound for A&E attendances.Conclusion:PAH incurs a heavy economic burden on a per-patient basis, highlighting the need for improved treatment strategies able to reduce disease progression and hospitalisations.The reviews of this paper are available via the supplemental material section.