Societal Costs Associated With Pulmonary Arterial Hypertension Subgroups: A Study Utilizing Linked National Registries

ABSTRACT Pulmonary arterial hypertension (PAH) is a heterogenic diagnosis including idiopathic and hereditary PAH (IPAH/HPAH) and groups associated to connective tissue disease (APAH‐CTD) and congenital heart disease (APAH‐CHD). Pre‐ and post‐diagnosis societal costs in PAH subgroups are not well kn...

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Main Authors: Barbro Kjellström, Bodil Ivarsson, Magnus Husberg, Lars‐Åke Levin, Lars Bernfort
Format: Article
Language:English
Published: Wiley 2025-04-01
Series:Pulmonary Circulation
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Online Access:https://doi.org/10.1002/pul2.70074
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author Barbro Kjellström
Bodil Ivarsson
Magnus Husberg
Lars‐Åke Levin
Lars Bernfort
author_facet Barbro Kjellström
Bodil Ivarsson
Magnus Husberg
Lars‐Åke Levin
Lars Bernfort
author_sort Barbro Kjellström
collection DOAJ
description ABSTRACT Pulmonary arterial hypertension (PAH) is a heterogenic diagnosis including idiopathic and hereditary PAH (IPAH/HPAH) and groups associated to connective tissue disease (APAH‐CTD) and congenital heart disease (APAH‐CHD). Pre‐ and post‐diagnosis societal costs in PAH subgroups are not well known. By linking Swedish national databases, societal costs in a national PAH cohort 5 years before and 5 years after diagnosis were estimated and compared to an age, sex, and geographically matched control group (1:5 match). Incident patients diagnosed 2008–2019 were included (patient/control; IPAH/HPAH = 393/1965, APAH‐CTD = 261/1305, APAH‐CHD = 89/445). Pre‐diagnosis mean societal costs were 2.9, 3.4, and 4.3 times higher for IPAH/HPAH, APAH‐CTD and APAH‐CHD patients, respectively, than controls. Post‐diagnosis, mean costs had increased 3.1, 2.0, and 1.6 times further for IPAH/HPAH, APAH‐CTD and APAH‐CHD respectively, while it decreased in all control groups. Main cost driver pre‐diagnosis were indirect costs (productivity loss) in both patient and control groups, however, 2.7–4.5 times higher in the patient groups. Post‐diagnosis, the main cost driver for all groups were health care costs (in‐ and outpatient‐care, drugs) that had increased 7.8, 5.4 and 6.8 times for IPAH/HPAH, APAH‐CTD and APAH‐CHD, respectively. Corresponding increase for controls were 17%–48%. For the PAH groups, drug treatment accounted for 70%–81% of the direct costs, while hospitalizations were the main driver for the control groups. In conclusion, PAH was associated with large societal costs. Pre‐diagnosis, APAH‐CHD had the highest societal costs, both in relation to their control group and compared to the other patient groups. Post‐diagnosis, highest societal costs were seen in IPAH/HPAH.
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spelling doaj-art-e45f71530d6b4e25ae4e08b9605e2c8b2025-08-20T02:38:14ZengWileyPulmonary Circulation2045-89402025-04-01152n/an/a10.1002/pul2.70074Societal Costs Associated With Pulmonary Arterial Hypertension Subgroups: A Study Utilizing Linked National RegistriesBarbro Kjellström0Bodil Ivarsson1Magnus Husberg2Lars‐Åke Levin3Lars Bernfort4Department of Clinical Sciences Lund Clinical Physiology and Skåne University Hospital, Lund University Lund SwedenDepartment of Clinical Sciences Lund Cardiothoracic Surgery and Medicine Services University Trust, Region Skåne, Lund University Lund SwedenDepartment of Health, Medicine and Caring Sciences Linköping University Linköping SwedenDepartment of Health, Medicine and Caring Sciences Linköping University Linköping SwedenDepartment of Health, Medicine and Caring Sciences Linköping University Linköping SwedenABSTRACT Pulmonary arterial hypertension (PAH) is a heterogenic diagnosis including idiopathic and hereditary PAH (IPAH/HPAH) and groups associated to connective tissue disease (APAH‐CTD) and congenital heart disease (APAH‐CHD). Pre‐ and post‐diagnosis societal costs in PAH subgroups are not well known. By linking Swedish national databases, societal costs in a national PAH cohort 5 years before and 5 years after diagnosis were estimated and compared to an age, sex, and geographically matched control group (1:5 match). Incident patients diagnosed 2008–2019 were included (patient/control; IPAH/HPAH = 393/1965, APAH‐CTD = 261/1305, APAH‐CHD = 89/445). Pre‐diagnosis mean societal costs were 2.9, 3.4, and 4.3 times higher for IPAH/HPAH, APAH‐CTD and APAH‐CHD patients, respectively, than controls. Post‐diagnosis, mean costs had increased 3.1, 2.0, and 1.6 times further for IPAH/HPAH, APAH‐CTD and APAH‐CHD respectively, while it decreased in all control groups. Main cost driver pre‐diagnosis were indirect costs (productivity loss) in both patient and control groups, however, 2.7–4.5 times higher in the patient groups. Post‐diagnosis, the main cost driver for all groups were health care costs (in‐ and outpatient‐care, drugs) that had increased 7.8, 5.4 and 6.8 times for IPAH/HPAH, APAH‐CTD and APAH‐CHD, respectively. Corresponding increase for controls were 17%–48%. For the PAH groups, drug treatment accounted for 70%–81% of the direct costs, while hospitalizations were the main driver for the control groups. In conclusion, PAH was associated with large societal costs. Pre‐diagnosis, APAH‐CHD had the highest societal costs, both in relation to their control group and compared to the other patient groups. Post‐diagnosis, highest societal costs were seen in IPAH/HPAH.https://doi.org/10.1002/pul2.70074health care resource utilizationnational registryproductivity losspulmonary hypertension
spellingShingle Barbro Kjellström
Bodil Ivarsson
Magnus Husberg
Lars‐Åke Levin
Lars Bernfort
Societal Costs Associated With Pulmonary Arterial Hypertension Subgroups: A Study Utilizing Linked National Registries
Pulmonary Circulation
health care resource utilization
national registry
productivity loss
pulmonary hypertension
title Societal Costs Associated With Pulmonary Arterial Hypertension Subgroups: A Study Utilizing Linked National Registries
title_full Societal Costs Associated With Pulmonary Arterial Hypertension Subgroups: A Study Utilizing Linked National Registries
title_fullStr Societal Costs Associated With Pulmonary Arterial Hypertension Subgroups: A Study Utilizing Linked National Registries
title_full_unstemmed Societal Costs Associated With Pulmonary Arterial Hypertension Subgroups: A Study Utilizing Linked National Registries
title_short Societal Costs Associated With Pulmonary Arterial Hypertension Subgroups: A Study Utilizing Linked National Registries
title_sort societal costs associated with pulmonary arterial hypertension subgroups a study utilizing linked national registries
topic health care resource utilization
national registry
productivity loss
pulmonary hypertension
url https://doi.org/10.1002/pul2.70074
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