May 20, 2019
During a session at ISPOR 2019, Naomi Sacks, PhD, director of Evidence Strategy and Generation at Precision Xtract, discussed the costs associated with paroxysmal supraventricular tachycardia (PSVT) and explained why costs differ depending on patient age and disease onset.
Dr Sacks kicked off her presentation explaining PVST. She said, “[PVST] is a sporadic, sudden and recurring tachycardia due to abnormal electrical pathways present in the heart at birth.”
According to Dr Sacks, PSVT is difficult to diagnose and patients may potentially be diagnosed with other cardiac rhythm disorders. Further, treatment options for patients with PSVT are limited. She said acute episodes are often treated with IV adenosine and other IV beta-blockers or calcium channel blockers in an emergency department (ED) setting. For chronic management, surveillance and prophylactic treatment with beta-blockers, calcium channel blockers or antiarrhythmic drugs are used. She noted that patients may also be treated with catheter ablation. This is considered curative.
Dr Sacks explained that little is known about health care resource utilization and costs before and after PSVT diagnosis. She said that past epidemiologic studies of the disease have found that PSVT prevalence increases with age and oftentimes a higher number of females are diagnosed. Notably, the outcomes of new diagnosed PSVT patients, including both the impact of diagnosis on expenditures, have not been studied. Finally, Dr Sacks said that the costs associated with catheter ablation are not known.
Hoping to compare the variations in health care costs by age group 3 years before and after PSVT diagnosis and characterize catheter ablations in the year following diagnosis, Dr Sacks and a team of researchers conducted a new study. Dr Sacks explained that she and her colleagues used health insurance claims form commercial payers for patients younger than 65 years of age to estimate the impact of PSVT on both costs and catheter ablations.
The research team used the IBM MarketScan Commercial research database. Included in the database was demographic, enrollment, and medical claims data. The total study period was January 1, 2008 through December 31, 2016.
The study population consisted of those newly diagnosed with the disease. More specifically, the researchers observed 13,092 patients. The majority of patients were between 41-64 years of age and there were more females across all age groups. The matched controls were not significantly different that patients with PSVT, Dr Sacks noted. Finally, they were observed for 3 years before and after index diagnosis.
According to Dr Sacks, prior to diagnosis, the costs in all age groups were relatively stable in the 13-36 months before index. However, the costs significantly increased in the year immediately following patient diagnosis. She did state, however, that in the second- and third-year following diagnosis, costs decreased but did not return completely to the pre-PSVT diagnosis levels.
Dr Sacks and her team of researchers also observed the costs of PSVT by setting. They found that the main drivers of higher costs were due to inpatient and outpatient services. They found that pharmacy spend was not a main driver of costs among any age group. Further, the costs for health care encounters with PSVT diagnoses accounted for more than two-thirds of cost increases in all age groups.
Based on the overall study findings, the research team found that average cost per health care encounter in the year following PSVT diagnosis ranged by age. Health care encounters included: inpatient admission, ED visit, outpatient hospital visit, and office visit. Patients younger than 18 had the following costs: $34,371, $849, $4023, and $170. Average costs for patients 18-40 included: $22,877, $982, $2352, and $163. Finally, the average cost per health care encounter for patients 41-64 were: $30,133, $1095, $1736, and $173. The cost per office visit was the only cost that remained similar across all age groups.
Finally, Dr Sacks and colleagues found that the proportion of patients treated with ablation in the year following PSVT diagnosis was highest among younger patients. Treatment with ablation decreased with age (P<.0001). The average cost of ablation ranged from $30,424 to $40,656, and Dr Sacks said that cost for an inpatient ablation was higher than outpatient hospital ablation across all age groups.