title: Cost-minimization analysis of treprostinil vs. epoprostenol as an alternate to oral therapy non-responders for the treatment of pulmonary arterial hypertension.
abstract: BACKGROUND
  Idiopathic pulmonary arterial hypertension (IPAH) is associated with substantial morbidity and mortality. Treprostinil was compared to epoprostenol for the economic impact of treating IPAH patients who failed or were not candidates for bosentan.
  
  
  METHODS
  The model was a cost-minimization analysis, assuming clinical equivalence was achieved by proper dosing of both drugs, in terms of survival and surrogate measures. Two theoretical cohorts of 270 patients were treated with subcutaneous treprostinil and intravenous epoprostenol, and were evaluated over 3 years using a spreadsheet model. Annual survival rates were estimated for the cohorts so that at endpoint 114 (42%) patients survived in both groups. The model utilized resource valuation data for medication and supply costs from Medicare; hospital, consultation, surgical, and diagnostic procedural fees from North Carolina hospitals; and costs to treat adverse events from published sources. Costs were obtained from standard lists and were presented as 2003 US dollars, discounted at 3%. Sensitivity analyses were performed testing all model uncertainties.
  
  
  RESULTS
  In the base case analysis, treprostinil demonstrated savings of 22,701 US dollars and 37,433 US dollars per patient over 1- and 3-year time horizons, respectively. The greatest savings came from reduced or minimal hospitalizations attributed to the dose titration and treatment of adverse events, such as sepsis, associated with epoprostenol and its delivery system. Probabilistic sensitivity analyses resulted in average 3-year cost-savings of 41,051 US dollars (Standard Deviation = 13,902 US dollars) per patient.
  
  
  CONCLUSIONS
  By initiating and continuing treatment with treprostinil over a 3-year period, the economic burden associated with IPAH may be reduced compared to treatment with epoprostenol. The greatest saving with treprostinil was attributed to decreased sepsis.
authors.affiliation: PharmIdeas USA Inc., Charlotte, NC, USA.
authors.forename: L
authors.initials: L
authors.lastname: Narine
authors.forename: L K
authors.initials: LK
authors.lastname: Hague
authors.forename: J H
authors.initials: JH
authors.lastname: Walker
authors.forename: C
authors.initials: C
authors.lastname: Vicente
authors.forename: R
authors.initials: R
authors.lastname: Schilz
authors.forename: O
authors.initials: O
authors.lastname: Desjardins
authors.forename: T R
authors.initials: TR
authors.lastname: Einarson
authors.forename: M
authors.initials: M
authors.lastname: Iskedjian
mesh_terms: D000284:Administration, Oral; D017046:Cost Savings; D017850:Economics, Pharmaceutical; D011464:Epoprostenol / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D009010:Monte Carlo Method; D015999:Multivariate Analysis
chemical_list: D011464:Epoprostenol; C427248:treprostinil