title: 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 US dollars and 2,781,438 US dollars 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 US dollars and 15,452 US dollars, 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.
authors.affiliation: Faculty of Pharmacy, University of Toronto, Toronto, Canada.
authors.forename: T R
authors.initials: TR
authors.lastname: Einarson
authors.forename: John T
authors.initials: JT
authors.lastname: Granton
authors.forename: Colin
authors.initials: C
authors.lastname: Vicente
authors.forename: John
authors.initials: J
authors.lastname: Walker
authors.forename: Greg
authors.initials: G
authors.lastname: Engel
authors.forename: Michael
authors.initials: M
authors.lastname: Iskedjian
mesh_terms: D000284:Administration, Oral; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D002170:Canada; D003363:Cost Control; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D017850:Economics, Pharmaceutical; D011464:Epoprostenol / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000191:economics*; D008297:Male; D009010:Monte Carlo Method; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D011464:Epoprostenol; C427248:treprostinil