Cost‐Effectiveness of Treprostinil Versus Epoprostenol in Patients with Pulmonary Arterial Hypertension: A Canadian Analysis

Abstract

BACKGROUND: Pulmonary arterial hypertension (PAH) is associated with substantial morbidity and mortality, exerting a tremendous health and economic impact on patients. In the present study, an economic evaluation of patients with PAH treated with either treprostinil or epoprostenol was performed. METHODS: A cost-minimization analysis (a cost-effectiveness subtype) was performed under the assumption that treprostinil and epoprostenol were clinically equivalent. Two cohorts of 60 patients, treated with treprostinil or epoprostenol, were evaluated over three years by using a dynamic spreadsheet model. The evaluation included both the provincial ministries of health and societal perspectives. Resource valuation data for drugs, medical supplies, consultations, and surgical and diagnostic procedures were obtained from standard lists. Costs of hospitalizations and adverse events were derived from published sources. Additional outpatient costs were considered equivalent and, therefore, were excluded from the analysis. Costs are presented in 2003 Canadian dollars discounted at 3%. Sensitivity analyses were performed testing all uncertainties in the model. RESULTS: In the base-case analysis (over three years), treatment with treprostinil resulted in an expected savings of $2,610,642 and $2,781,438 from the ministries of health and societal perspectives, respectively. On a per-patient level, treatment with treprostinil resulted in an average annual savings of $14,504 and $15,452, respectively. The greatest savings with treprostinil came from reduced hospitalizations. Multivariate sensitivity analyses estimated cost savings in greater than 99% of scenarios. CONCLUSIONS: By initiating and continuing treprostinil treatment over a three-year period, the economic burden associated with PAH may be reduced compared with epoprostenol treatment.

Long-term follow-up of portopulmonary hypertension: Effect of treatment with epoprostenol

“…Long‐term therapy with epoprostenol requires continuous administration and is therefore costly and often complicated by central venous line infections and pump failure 12, 13. Sepsis and subsequent hospitalizations greatly affect the cost‐effectiveness of this therapy 19, 20…”

Pharmacoeconomic evidence of bosentan for pulmonary arterial hypertension

“…Two assessments focused on bosentan plus conventional care versus conventional care alone [14,44], and one compared bosentan and treprostinil against patients treated with epoprostenol [15]. Two analyses assessed the cost-effectiveness of oral and inhaled therapies only [8,45], and a further two studies restricted their ana lysis to the cost-effectiveness of treprostinil versus epoprostenol [46,47]. Table 3 summarizes the results of cost-effective analyses considered here.…”

“…Our search for economic models of cost-effectiveness comparing treatments identified eight studies [8,[13][14][15][45][46][47]. Several studies [15,46,47] compared the pharmacoeconomics of bosentan with other drugs (e.g., epoprostenol and treprostinil).…”

“…Several studies [15,46,47] compared the pharmacoeconomics of bosentan with other drugs (e.g., epoprostenol and treprostinil). We have not included these reports in the current review because these agents are administered parenterally.…”

“…A comprehensive review by Chen and colleagues [13] evaluated the results of four RCTs conducted up to early 2007 [14,15,46,47] and cost-effectiveness submissions from pharmaceutical companies. The authors adopted specific inclusion criteria when selecting which trials to review.…”