Prevalence of pulmonary arterial hypertension in the Camerino area of central Italy and savings resulting from generic bosentan

Abstract

ObjectivePulmonary arterial hypertension is a rare and progressive respiratory disease characterised by high blood pressure and vascular resistance producing right ventricular fatigue. In Italy, pulmonary hypertension can be treated with different drugs available on the market at different costs, and in the Marche region distributed exclusively by hospital pharmacies. The present study examined in an area of the Marche region the use of drugs specifically indicated for pulmonary hypertension, and evaluated how the introduction of the generic bosentan might lower pharmaceutical costs for the healthcare budget.MethodsThe study examined oral administration prescriptions and costs using data from the Apotheke Gold (Record Data) database from 1 January 2012 to 31 August 2017.ResultsAnnually (from 1 January 2012 to 31 August 2017), an average of 4.83 patients were treated (prevalence of 102.35 cases per 1 million residents) with ambrisentan (Volibris), bosentan (Tracleer), macitentan (Opsumit), tadalafil (Adcirca) or sildenafil (Revatio). The total expenditure during the 5-year 8-month period was €472 405. Ambrisentan was by far the most expensive product overall, with a total expenditure of €222 380 for the period studied (a daily cost of €67.39), even though Tracleer had the highest cost for a day of treatment (a daily cost of €94.48, but a total expenditure of €163 976 for the period, due to its more recent marketing). Providing patients with the generic form bosentan in place of Tracleer would lower the costs dramatically. A very significant annual savings per patient of approximately €31 879 would be achieved, a striking 92.4% reduction in costs.ConclusionThe prevalence of pulmonary arterial hypertension reported for Camerino and its surrounding area in the Marches region is quite high compared with that reported by other authors for France and Scotland. The introduction of the generic bosentan would cut costs drastically. It is to be hoped that centralised procurement at the regional level would bring further savings.

Trends in age-specific and sex-specific pulmonary hypertension mortality in Italy between 2005 and 2017

“…Unfortunately, we were not able to derive any conclusion regarding the incidence of the disease or the new number of cases diagnosed yearly, because the WHO mortality only provides worldwide mortality data based on the ICD-10 codes. As a matter of a fact, data regarding the trend and/or incidence of pulmonary hypertension/PAH in Italy remain scant 10 . Most of current data derived from multicenter European registries, such as the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) 11 .…”

“…in Italy remain scant. 10 Most of current data derived from multicenter European registries, such as the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA). 11 The observed steady decline in age-standardized pulmonary hypertension-related mortality observed in Italy is probably multifactorial.…”

Efficacy of Beraprost Sodium Combined with Sildenafil and Its Effects on Vascular Endothelial Function and Inflammation in Patients Experiencing Left Heart Failure Complicated with Pulmonary Arterial Hypertension

“…Pulmonary arterial hypertension is a clinically common severe cardiovascular disease that can cause significant pulmonary vasoconstriction and thickening of the pulmonary artery intima, further increasing resistance in the pulmonary circulation, so it serves as a common risk factor for right heart failure. Chronic left heart failure can alter both structure and function of the heart in patients to obviously weaken cardiac filling and ejection, resulting in congestion in the pulmonary circulation [ 2 ]. Once patients have left heart failure complicated with pulmonary arterial hypertension, treatment is not satisfactory because of the critical disease conditions, and if no prompt and effective measures are performed, respiratory failure will occur in the early stages [ 3 ].…”