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A retrospective observational study of children (\u226418 years) with pulmonary hypertension was performed using data from the MarketScan\u00ae Commercial and Medicaid claims databases. Associations between etiology of pulmonary hypertension and pharmaceutical regimen were evaluated, as were the associations between subject social and geographic characteristics (insurance\u2010type, race, and\/or census region) and regimen. Annualized costs of single\u2010 and multi\u2010class regimens were calculated. In total, 873 subjects were studied, of which 94% received phosphodiesterase\u20105\u00a0inhibitors, 31% endothelin receptor antagonist, 9% prostacyclin analogs, and 7% calcium channel blockers. Monotherapy was used in 72% of subjects. Phosphodiesterase\u20105\u00a0inhibitors monotherapy was the most common regimen (93%). Subjects with idiopathic pulmonary hypertension, congenital heart disease, and unclassified pulmonary hypertension receive more than one agent and were more likely to receive both endothelin receptor antagonist and prostacyclin analogs than other forms of pulmonary hypertension. Compared to recipients of public insurance, subjects with commercial insurance were more likely to receive more intense therapy (<jats:italic>p<\/jats:italic>\u2009=\u20090.003), which was confirmed in multivariable analysis (OR: 1.4, <jats:italic>p<\/jats:italic>\u2009=\u20090.03). Receipt of commercial insurance was also associated with increased annual costs across all subjects (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and for the most common specific regimens. The majority of children with pulmonary hypertension receive phosphodiesterase monotherapy, followed by phosphodiesterase\u2013endothelin receptor antagonist two drug regimens, and finally the addition of prostacyclin analogs for three\u2010drug therapy. However, even after adjustment for measurable confounders, commercial insurance was associated with higher intensity care and higher costs (even within specific classes of pulmonary vasodilators). The effect of these associations on clinical outcome cannot be discerned from the current data set, but patterns of treatment deserve further attention.<\/jats:p>","DOI":"10.1177\/2045894020933083","type":"journal-article","created":{"date-parts":[[2020,5,26]],"date-time":"2020-05-26T12:21:50Z","timestamp":1590495710000},"page":"1-9","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Variation in the use of pulmonary vasodilators in children and adolescents with pulmonary hypertension: a study using data from the MarketScan\u00ae insurance claims database"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6023-1634","authenticated-orcid":false,"given":"Michael L.","family":"O'Byrne","sequence":"first","affiliation":[{"name":"Division of Cardiology The Children's Hospital of Philadelphia Philadelphia PA USA"},{"name":"Department of Pediatrics Perelman School of Medicine at the University of Pennsylvania Philadelphia PA USA"},{"name":"Center for Pediatric Clinical Effectiveness The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA USA"},{"name":"Leonard Davis Institute and Center for Cardiovascular Outcomes Quality, and Evaluative Research University of Pennsylvania Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer A.","family":"Faerber","sequence":"additional","affiliation":[{"name":"Center for Pediatric Clinical Effectiveness The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Katcoff","sequence":"additional","affiliation":[{"name":"Center for Pediatric Clinical Effectiveness The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David B.","family":"Frank","sequence":"additional","affiliation":[{"name":"Division of Cardiology The Children's Hospital of Philadelphia Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Davidson","sequence":"additional","affiliation":[{"name":"Division of Cardiology The Children's Hospital of Philadelphia Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Therese M.","family":"Giglia","sequence":"additional","affiliation":[{"name":"Division of Cardiology The Children's Hospital of Philadelphia Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine M.","family":"Avitabile","sequence":"additional","affiliation":[{"name":"Division of Cardiology The Children's Hospital of Philadelphia Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,6]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2009.182378"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.026591"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acvd.2009.12.001"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.969584"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.13-0636"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-309103"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.026591"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2009.182378"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2010.02.023"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1413687"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02043-2015"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.02.575"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000329"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-309103"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951116002493"},{"key":"e_1_2_10_17_1","unstructured":"The Truven Health MarketScan Databases for Health Services Researchers.truvenhealth.commarketslife\u2010sciencesproductsdata\u2010toolsmarketscan\u2010databases; 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