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Cost-utility of treatments for pulmonary arterial hypertension: a Markov state-transition decision analysis model.

Abstract：

BACKGROUND AND OBJECTIVE:Clinicians must choose between an increasing number of medications for the treatment of pulmonary arterial hypertension (PAH) with different routes of administration, adverse effects, costs and efficacies. We constructed a decision analysis to help inform treatment choices in PAH. METHODS:We created a Markov-type model to evaluate 1-year treatment with bosentan, treprostinil, epoprostenol, inhaled iloprost, sildenafil, sitaxentan and ambrisentan. Transition probabilities were based on observed transitions between WHO functional classes, adjusted by relative risk of improvement in a 6-minute walk test. Utilities were based on reported values for each functional class, adjusted for burden of treatment administration. Costs were estimated from Medicare and Medicaid reimbursement data. Sensitivity analyses evaluated changes in efficacy, utilities and costs. RESULTS:Treatment with sildenafil was less costly and resulted in a greater gain in quality-adjusted life-years (QALYs) compared with other treatments. Treatment with ambrisentan and bosentan resulted in the same gain in QALYs as sildenafil, but at a higher cost. Sensitivity analyses had minimal impact on these results. CONCLUSIONS:Based on this model, sildenafil is a cost-effective treatment for PAH with a low price and a net increase in QALYs. The results from this analysis are a tool to help guide clinicians in deciding which PAH medications to use; however, the final decisions should be individualized because the effectiveness of therapy, resulting utilities and acceptable costs will differ with each patient.

journal_name

Clin Drug Investig

journal_title

Clinical drug investigation

authors

Garin MC,Clark L,Chumney EC,Simpson KN,Highland KB

doi

10.2165/11317820-000000000-00000

subject

Has Abstract

pub_date

2009-01-01 00:00:00

pages

635-46

issue

10

eissn

1173-2563

issn

1179-1918

pii

2

journal_volume

29

pub_type

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