Exploring Providers' Behaviors, Attitudes, and Preferences on the Treatment of Pulmonary Arterial Hypertension With Endothelin Receptor Antagonist (ERA) + Phosphodiesterase-5 Inhibitors (PDE5i).

Abstract

This study aims to understand healthcare providers' (HCPs) decision to adopt double combination therapy with ERA + PDE5i for pulmonary arterial hypertension (PAH), and to explore whether a single tablet combination therapy (STCT) might increase adoption practices. 195 US HCPs completed a survey evaluating their PAH treatment preferences. HCPs' willingness to use double combination ERA + PDE5i was assessed using a discrete choice experiment (DCE). The sample predominantly included physicians (73.3%) from centers of excellence (63.1%), with a mean of 117.4 PAH patients treated in the past year. Key factors influencing ERA + PDE5i adoption in the DCE were the patient's current treatment (17.9), PAH etiology (16.2), existing comorbidities (14.1), and history of side effects (12.7), with higher scores indicating stronger preference. HCPs were more likely to select ERA + PDE5i for patients currently on PDE5i monotherapy, with idiopathic PAH, and without comorbidities or a history of side effects. Regarding STCT, most HCPs reported that it would allow them to initiate ERA + PDE5i sooner (76.4%) and improve patient compliance (82.6%). However, concerns regarding cost/insurance issues (63.6%) and a history of side effects (50.8%) were identified as limitations to adopting STCT. Patients' current therapy, the cause of PAH, comorbidities, and side effects are key factors influencing whether US providers are willing to treat them with ERA + PDE5i. Providers perceive that STCT may help HCPs initiate ERA + PDE5i sooner, improve compliance, and simplify initiation of upfront double therapy and delivery of triple therapy. Addressing cost and insurance barriers will be critical to realizing these potential benefits.