title: [Efficiency of initiation with ambrisentan versus bosentan in the treatment of pulmonary arterial hypertension].
abstract: OBJECTIVE
  To evaluate the efficiency of initiation with endothelin receptor antagonists, ambrisentan or bosentan, followed by sequential combination with phosphodiesterase-5 inhibitors and prostanoids in the treatment of pulmonary arterial hypertension, from the Spanish National Health System perspective.
  
  
  METHODS
  A Markov model was developed based on the four New York Heart Association functional classes. A panel of three experts reached a consensus on patient management based on clinical practice. Patients revised their treatment every 12 weeks, based on their health status and previous medication records. Pharmacological treatment costs and costs associated with very frequent adverse events (AE) were considered in a horizon of 60 weeks. Outcomes were measured in qualityadjusted life years (QALY). A probabilistic sensitivity analysis was performed.
  
  
  RESULTS
  No clinically relevant differences in QALY per-patient and year were found for initiation with ambrisentan and bosentan: 0.6853 and 0.6902, respectively. Initiation with ambrisentan resulted in lower pharmacological treatment and AE management costs: ?35,550 and ?117 versus ?40,224 and ?171. In the sensitivity analysis, initiation with ambrisentan resulted in a negative significant cost difference: ?-4,982; CI95%[?- 8,014; ?-2,500]; while no significant differences in QALY were found: -0.0044; CI95%[-0.0189; 0.0101].
  
  
  CONCLUSIONS
  Initiation with ambrisentan followed by sequential combination with phosphodiesterase-5 inhibitors and prostanoids yields comparable outcomes at lower costs than initiation with bosentan.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Villa
authors.forename: Raúl
authors.initials: R
authors.lastname: Morano
authors.forename: Antonio
authors.initials: A
authors.lastname: Román
authors.forename: Joan
authors.initials: J
authors.lastname: Gil
mesh_terms: D000077300:Bosentan; D056486:Chemical and Drug Induced Liver Injury / Q000191:economics / Q000209:etiology; D002986:Clinical Trials as Topic / Q000191:economics; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D004232:Diuretics / Q000191:economics / Q000627:therapeutic use; D016527:Drug Costs; D004359:Drug Therapy, Combination; D004487:Edema / Q000139:chemically induced / Q000188:drug therapy / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000191:economics; D008390:Markov Chains; D018803:Models, Economic; D015337:Multicenter Studies as Topic / Q000191:economics; D009313:National Health Programs / Q000191:economics; D010666:Phenylpropionates / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D058986:Phosphodiesterase 5 Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D011453:Prostaglandins / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D011724:Pyridazines / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D013449:Sulfonamides / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D010666:Phenylpropionates; D058986:Phosphodiesterase 5 Inhibitors; D011453:Prostaglandins; D011724:Pyridazines; D013449:Sulfonamides; C467894:ambrisentan; D000077300:Bosentan