Abstract
Purpose: To describe first and second line treatment pattern among PH patients enrolled in managed care health plan.
Methods: Data were derived from the MarketScan claims database. PH patients were identified anytime during 4/1/2006 to 3/31/2009 using the ICD-9 claim of 416.X. First line therapy was defined as the first PH-related pharmacy claim within ±12 months of the diagnosis claim. Second line treatment was defined as separate PH-related pharmacy claim post the first line PH-related pharmacy claim. PH-related treatment included prescriptions for high-dose calcium channel blockers (CCBs), endothelin receptor antagonists (ERAs), phosphodiesterase type 5 inhibitors (PDE5s), or prostacyclin analogues (PAs). CCB users had no diagnosis claim of essential hypertension anytime during the study period.
Results: Final study sample was 2,252, with a mean age of 61.2 years (SD+16.41), and 57% females. 46% of PH-patients had CCB as the first line treatment followed by PDE5s (38%), ERAs (13%), and PAs (3%). 16% of the sample had some second line treatment over a 12-month follow-up. Combination therapy was only observed in the CCB-cohort, where 39 patients added an ERA/PDE5/PA to their current treatment. Switching was most common among ERA (61%) and PA (50%) first line users, with majority switching to PDE5. Total average treatment days for first-line PH-prescription varied from a low of 21 (SD=81.44) days among PA-users to 266 (SD=131.39) among ERA-users, respectively.
Conclusions: CCBs and PDE5 were the most prescribed first line treatment among PH-patients. Future research would need to explore the choice of first line treatment on clinical and economic outcomes.
- © 2011 ERS