PURPOSE: Pulmonary arterial hypertension (PAH) results in a progressive increase in pulmonary vascular resistance, right heart failure, and eventually death. Although current therapies for PAH improve functional status, quality of life, and in some cases survival, the high cost of these pharmacological therapies has been a concern. In this study, our goal is to perform a cost analysis of the current treatment of PAH and compare it with other accepted treatment options for various disease processes.
METHODS: We compared the average cost needed to prevent one death per year between diseases. This was obtained by multiplying the average treatment cost per year with the number needed to treat (NNT) to prevent mortality in one year. Mortality benefits were estimated by comparing survival data with a mortality formula derived form the National Institute of Health experience. Average wholesale prices (AWP) were obtained for pharmacological agents from inquiries of the pharmacy at Cleveland Clinic Florida. For procedural therapies, costs were obtained based on Medicare payments.
RESULTS: In the treatment of PAH, Bosentan cost was estimated at $406,000 per life saved, Epoprostenol cost was estimated at $968,000 per life saved, subcutaneous Treprostinil cost was estimated at $1,715,000 per life saved and inhaled Iloprost cost was estimated $873,000 per life saved. Mortality data of Sildenafil was not included in the analysis. Implantable automatic cardiac defibrillator costs $315,000 per life saved, left ventricular assist devices costs $654,968 per life saved, the treatment of follicular non-Hodgkin's lymphoma with Cyclophosphamide, Adriamycin, Vincristine, Prednisone and Rituximab costs $1,080,000 per life saved, pacemakers for atrial fibrillation costs $1,795,846 per life saved, and treatment of lupus nephritis with Mycophenolate mofetil costs $16,065,000 per life saved.
CONCLUSION: The cost of various pharmacological agents used to treat PAH are at an acceptable cost effectiveness range for pharmacotherapeutic and biotechnological interventions.
CLINICAL IMPLICATIONS: The PAH pharmacological agents are a reasonable treatment modality for this disease state.
DISCLOSURE: Franck Rahaghi, No Product/Research Disclosure Information; Consultant fee, speaker bureau, advisory committee, etc. Dr. Rahaghi has attended advisory meetings or has been sponsored for speaking engagements by Baxter Healthcare Inc., CSL Behring, Actelion Pharmaceuticals, Encysive, Gilead Therapeutics and Pfizer. Inc.