Initiating selexipag within 12 months of PAH diagnosis may reduce hospitalizations, costs
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NASHVILLE, Tenn. — Initiation of oral selexipag within 12 months of pulmonary arterial hypertension diagnosis may reduce all-cause hospitalizations and overall medical costs, according to a new analysis.
“One of the key take-home findings is that earlier initiation of PAH combination therapy can deliver improvement in outcomes, particularly reduction in all-cause hospitalizations,” Sumeet Panjabi, PhD, Senior Director, Real World Value & Evidence, Janssen Scientific Affairs, told Healio. “PAH patients exhibit high rates of hospitalizations including ICU admissions and, given almost 70% of patients remain on monotherapy, patients are often sub-optimally treated. There is a large opportunity for patients to be treated with more effective combination therapy, whether that is double or triple combination therapy, to improve outcomes and reduce the risk of hospitalization.”
The aim of the current retrospective cohort study was to assess the impact of selexipag (Uptravi, Janssen) use within 12 months of diagnosis on rates of hospitalization and medical costs in real-world clinical practice.
The study included 1,083 adults with newly diagnosed PAH who received a PAH medication within 12 months following their diagnosis including 70 patients (66.3% women) who initiated selexipag and 1,013 patients (63% women) who did not initiate any prostacyclin pathway agent (PPA).
The most commonly used therapies in the selexipag group were combination therapies including oral selexipag plus a phosphodiesterase-5 inhibitor (40.6%) and oral selexipag plus an endothelin receptor antagonist (33.4%) or a combination of all three (17.2%). Most patients in the group that did not initiate any PPAs were treated with only one medication class (PDE5 inhibitor, 63.1%; endothelin receptor antagonist, 11.4%; soluble guanylate cyclase stimulator, 4.4%).
The rate of all-cause hospitalizations per 100 person-years was lower in the group that initiated selexipag within 12 months compared with the group that did not initiate PPA therapy (83 vs. 106; P = .039). However, the rate of PAH-related hospitalizations per 100 person-years was similar among the two groups (69 vs. 65), according to the results.
After adjusting for potential confounders, those who initiated selexipag within 12 months had a significantly lower rate (24%) of all-cause hospitalizations (incidence rate ratio = 0.76; 95% CI, 0.6-0.96), the researchers reported.
Annualized all-cause total per person per year (PPY) medical costs were significantly higher for patients who did not initiate any PPA within 12 months ($48,355 vs. $26,331; P = .0002). Those who did not initiate any PPA also had significantly higher hospitalization costs ($25,866 vs. $11,396; P = .0001) and physician visit utilization costs ($3,341 vs. $2,156; P = .004) compared with those who initiated selexipag within 12 months, according to the results.
PAH-related total costs ($22,121 vs. $13,763; P = .0241) and PAH-related hospitalization costs ($16,936 vs. $9,316; P = .0233) also were significantly higher in the non-PPA group. However, PAH-related ED visit costs were higher but not significantly so in the group that initiated early selexipag ($694 vs. $398), results showed.
“Our hypothesis going into the study was that we expected to see greater benefit in patients who initiated selexipag within 12 months. The findings really bore that out. I think that is a testament to the GRIPHON study, which studied selexipag and is one of the largest trials done in PAH. Being able to validate those findings in the real world reinforces how well the therapy works for patients in clinical practice,” Panjabi told Healio.
Panjabi said a number of further studies are planned, looking at selexipag as part of a triple combination compared with double combination and outcomes of patients treated very selectively including with selexipag and macitentan (Opsumit, Janssen) together, for example.
This poster is being presented in the PAH Abstract Posters session Tuesday, Oct. 18, at CHEST 2022.