sildenafil most cost effective pah treatment

PharmacoEconomics & Outcomes News 587 - 19 Sep 2009 Sildenafil most cost effective PAH treatment Sildenafil may be dominant or cost saving over five other treatment options according to a study comparing their cost effectiveness for pulmonary arterial hypertension (PAH). A Markov state-transition model was used to estimate the cost effectiveness of bosentan, treprostinil, epoprostenol [prostacyclin], inhaled iloprost, sildenafil, sitaxentan and ambrisentan. Transition probabilities were based on observed transitions between WHO functional classes for bosentan, which were adjusted for the other medications by comparing published patient performances on the 6-minute walk test. The time horizon of the model was 12 months, and direct costs per patient were based on the 2006 Medicare/Medicaid reimbursement rates in South Carolina (2006 $US). Sildenafil was found to be dominant or cost saving over all other medications tested, demonstrating both lower costs ($2.7 million to $6.6 million) and greater or equal QALYs (0 to 5.92) per 100 patients [see table]. Bosentan and ambrisentan were both also dominant over epoprostenol and iloprost, and cost effective against sitaxentan. While iloprost was associated with 2.67 and 2.82 incremental QALYs above epoprostenol and treprostinil, respectively, these came at costs of around $1.1 million and $1.4 million per QALY gained. Researchers concluded that "sildenafil may be a logical starting point for patients. . .with bosentan and ambrisentan (or sitaxentan when commercially available) as reasonable options for patients for whom sildenafil is not adequate". Selected ICERs between different PAH treatments ICER a ($US/QALY) versus comparator Sildenafil Bosentan b Sitaxentan Comparator: Bosentan cost saving - - Treprostinil dominant 73 482 75 452 Epoprostenol dominant dominant dominant Iloprost dominant dominant dominant Sitaxentan dominant 2950 - a incremental cost-effectiveness ratio b Bosentan and ambrisentan results were identical under the base-case scenario. Garin MC, et al. Cost-utility of treatments for pulmonary arterial hypertension: a Markov state-transition decision analysis model. Clinical Drug Investigation 29: 635-646, No. 10, 1 Oct 2009 801131782 1 PharmacoEconomics & Outcomes News 19 Sep 2009 No. 587 1173-5503/10/0587-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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PharmacoEconomics & Outcomes News 587 - 19 Sep 2009

Sildenafil most cost effective PAHtreatment

Sildenafil may be dominant or cost saving over fiveother treatment options according to a study comparingtheir cost effectiveness for pulmonary arterialhypertension (PAH).

A Markov state-transition model was used to estimatethe cost effectiveness of bosentan, treprostinil,epoprostenol [prostacyclin], inhaled iloprost, sildenafil,sitaxentan and ambrisentan. Transition probabilitieswere based on observed transitions between WHOfunctional classes for bosentan, which were adjusted forthe other medications by comparing published patientperformances on the 6-minute walk test. The timehorizon of the model was 12 months, and direct costsper patient were based on the 2006 Medicare/Medicaidreimbursement rates in South Carolina (2006 $US).

Sildenafil was found to be dominant or cost savingover all other medications tested, demonstrating bothlower costs ($2.7 million to $6.6 million) and greater orequal QALYs (0 to 5.92) per 100 patients [see table].Bosentan and ambrisentan were both also dominantover epoprostenol and iloprost, and cost effectiveagainst sitaxentan. While iloprost was associated with2.67 and 2.82 incremental QALYs above epoprostenoland treprostinil, respectively, these came at costs ofaround $1.1 million and $1.4 million per QALY gained.Researchers concluded that "sildenafil may be a logicalstarting point for patients. . .with bosentan andambrisentan (or sitaxentan when commerciallyavailable) as reasonable options for patients for whomsildenafil is not adequate".

Selected ICERs between different PAH treatmentsICERa ($US/QALY) versus comparator

Sildenafil Bosentanb Sitaxentan

Comparator:Bosentan cost saving - -Treprostinil dominant 73 482 75 452Epoprostenol dominant dominant dominantIloprost dominant dominant dominantSitaxentan dominant 2950 -a incremental cost-effectiveness ratiob Bosentan and ambrisentan results were identical under the base-casescenario.

Garin MC, et al. Cost-utility of treatments for pulmonary arterial hypertension: aMarkov state-transition decision analysis model. Clinical Drug Investigation 29:635-646, No. 10, 1 Oct 2009 801131782

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