Open Access Highly Accessed Research article

Demographics, clinical characteristics, health resource utilization and cost of chronic thromboembolic pulmonary hypertension patients: retrospective results from six European countries

Bernd Schweikert1*, David Pittrow2, Carmine Dario Vizza3, Joanna Pepke-Zaba4, Marius M Hoeper5, Anja Gabriel6, Jenny Berg7 and Mirko Sikirica8

Author Affiliations

1 OptumInsight, Konrad-Zuse-Platz 11, D- 81829 Munich, Germany

2 Institute for Clinical Pharmacology, Technical University, Dresden, Germany

3 Department of Cardiovascular and Respiratory Science, School of Medicine, University of Rome “Sapienza”, Rome, Italy

4 Papworth Hospital NHS Trust, Cambridge, United Kingdom

5 Hanover Medical School, Hanover, Germany

6 Bayer Pharma AG, Wuppertal, Germany

7 OptumInsight, Stockholm, Sweden

8 Bayer Pharma AG, Berlin, Germany

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BMC Health Services Research 2014, 14:246  doi:10.1186/1472-6963-14-246

Published: 9 June 2014



Chronic Thromboembolic Pulmonary Hypertension (CTEPH) results from incomplete resolution of a pulmonary embolus, leading to pulmonary hypertension and progressive right heart failure and death. We aimed to describe the demographics, treatment patterns, health resource utilization and related costs of patients with CTEPH.


In specialized PH centres across six European countries, medical charts of CTEPH patients on PH medication were retrospectively extracted (chart review between 2006 and 2009). Resource utilization was valued using country-specific unit costs. Descriptive statistical analyses were performed.


Twenty-one hospitals documented 119 consecutive CTEPH patients over an average of 25.4 months. Patients were inoperable (83.9%) or persistent after surgery (16.0%) with mean age 67.5 ± 12.3 years, 61% were female. The average 6-minute walking distance was 298 ± 120 meters, and NYHA class II/III/IV was 27/59/14%. At baseline, 59.7% patients received endothelin receptor antagonist, 34.4% phosphodiesterase-5 inhibitors, and 5.8% prostacyclin. Adding a second PH medication was the most common regimen change. CTEPH patients experienced 1.8 ± 2.2 hospitalizations per year accounting for 14.8 ± 26.1 days in hospital. Patients paid on average 2.8 office visits per year to their general practitioner and 1.3 visits to a specialist. Unadjusted annual mortality rate was 6.0%. Annual cost of PH specific medication was the predominant economic factor averaging € 36,768 per year. Costs for hospitalizations (€ 4,496) and concomitant medications (€ 2,510) were substantially lower. Other health care resource items only accounted for marginal additional costs.


CTEPH patients are characterised by substantial morbidity and mortality. Health care utilisation, predominantly due to off-label use of PH drugs, is significant.

Retrospective; Chart review; Pulmonary hypertension; Treatment; Cost