A paper titled “Economic and Social Burden of Pulmonary Arterial Hypertension in Italy: A Cost-of-Illness Study” was recently pubclished in Drugs Real World Outcomes journal. The aim of the authors was to estimate the economic and social burden of pulmonary arterial hypertension (PAH) in Italy, including direct healthcare costs, direct non-healthcare costs, and indirect costs related to productivity loss.
Methodology
A bottom-up prevalence-based cost-of-illness model was developed using epidemiological data and healthcare resource consumption from national and international literature, validated by a panel of expert clinicians with extensive experience in the management of the condition across different regions of Italy. The analysis was conducted from a societal perspective over a 1-year horizon.
Results
In Italy pulmonary arterial hypertension affects 2,100-3,500 people, with an annual economic burden of 263-438 million euros. The average cost per patient is approximately 125,000 euros annually, increasing significantly with disease severity—from €46,303 for Functional Class I to €252,176 for Functional Class IV.
This expenditure is composed of 74% direct healthcare costs, 9% direct non-healthcare costs, and 17% indirect costs. In general, the primary driver of direct costs is related to drug expenses. The variable with the greatest impact on the average cost per patient is the annual treatment cost of triple therapy endothelin receptor antagonist (ERA) + phosphodiesterase type-5 inhibitor (PDE5i) + prostacyclin (PCY).
Patients in FC IV—representing only 11% of the pulmonary arterial hypertension population—are responsible for 22% of total costs, highlighting the disproportionate burden of advanced disease.
Conclusions
These findings underscore the critical importance of early intervention, which serves a dual purpose: improving patient outcomes while simultaneously reducing the substantial economic burden associated with disease progression. Given that costs increase dramatically with disease severity preventing progression to more advanced stages represents both a clinical and economic imperative.
Other countries
Limited research exists on pulmonary arterial hypertension’s economic burden in Europe. Available studies show significant costs across different countries: France reported annual hospitalization costs of about 3.6 million euros, with an average hospital stay costing 2,860 euros. In the UK, the annual economic burden averaged £8.6 million (2013-2017), predominantly from hospitalizations. Spain’s annual costs ranged from 68 to 106 million euros, while Sweden estimated costs at 176,600 euros per patient over 5 years post-diagnosis, including hospitalizations, outpatient care, medications, and productivity loss. A global systematic review found monthly costs per patient ranging from $2,476 to $11,875.
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Citation
Paoletti, M., Vizza, D., D’Alto, M. et al. Economic and Social Burden of Pulmonary Arterial Hypertension in Italy: A Cost-of-Illness Study. Drugs – Real World Outcomes (2025). https://doi.org/10.1007/s40801-025-00520-y