From the Journals

Phosphodiesterase-5 inhibitors often prescribed inappropriately

Publish date: March 9, 2018

 

FROM ANNALS OF THE AMERICAN THORACIC SOCIETY


Doctor talking to an elderly patient. Dean Mitchell/Thinkstock
Among 108,777 veterans with at least one ICD-9CM diagnosis code for PH, 2,790 (2.6% 95% confidence interval, 2.5-2.7%) received daily treatment with PDE5is. Among these, 541 (19.4% [18.0-20.9%]) were being treated appropriately, 1,711 (61.3% [95% CI, 59.5%-63.1%]) were receiving potentially inappropriate treatment, and 358 (12.8% [11.6%-14.1%]) were receiving treatment of uncertain value.

In a chart abstraction analysis from a randomly selected subset of PDE5i-treated patients, half (110/230, 47.8% [41.3%-54.5%]) had documented right heart catheterization to confirm the presence of PH. After factoring this into their algorithm, the investigators determined that only 11.7% [8.0%-16.8%] of these patients received clearly appropriate treatment.

Over the 8-year study period, the number of patients with PH group 2 or 3 prescribed PDE5i rose more than 14-fold, the researchers said. They speculated that this figure was likely to continue to rise with the increasing use of echocardiography and detection of PH.

According to the authors, the cost of treating one PH patient for 1 year with PDE5i therapy was between $10,000 and $13,000.

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