The Clinical and Economic Burden of Pulmonary Arterial Hypertension in Israel, 2014-2022: A Retrospective Analysis of Healthcare Costs and Utilization.

Pulmonary arterial hypertension (PAH) is a rare, progressive disease with high morbidity and mortality. Real-world data from Israel are scarce. This study aimed to estimate the incidence, describe treatment patterns, and quantify healthcare utilization and costs associated with PAH in Israel. We conducted a retrospective cohort study using electronic medical records from Maccabi Healthcare Services. Patients diagnosed with PAH between 2014 and 2022 were identified using a multi-criteria case definition combining administrative, clinical, and free-text data. Patients with PAH were compared to two control groups: a matched non-PAH cohort and a cohort with heart failure with reduced ejection fraction (HFrEF). Healthcare resource utilization (HCRU) and costs were annualized and compared using adjusted regression models accounting for age, sex, comorbidities, and socioeconomic status. A total of 106 patients met the diagnostic criteria for PAH, corresponding to an incidence of 0.83 cases per 100,000 person-years (95% CI: 0.66 to 1.00). The cohort was predominantly female (74%) with a mean age of 65 years. One-year mortality among patients with PAH was approximately 20 times higher than in non-PAH controls and 5 times higher than in patients with HFrEF. Mean annual healthcare costs were 12.2 times higher than in non-PAH controls and 6.5 times higher than in patients with HFrEF, with medications accounting for 79% of total expenditures. PAH imposes a substantial clinical and economic burden in Israel, driven by medication costs with widespread use of monotherapy despite full coverage of combination therapy, supporting the case for concentrated care in expert centers.