Cost-utility analysis of Macitentan Vs. Bosentan in pulmonary atrial hypertension
Objective: Endothelin (ET) receptor antagonists (ERAs) have considerable improvements in pulmonary arterial hypertension (PAH) patients’ symptoms. Macitentan, a novel ERA, has more significant positive effects like reduction of morbidity and mortality in PAH patients by 45% and decreases PAH hospita...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2020-01-01
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| Series: | Journal of Family Medicine and Primary Care |
| Subjects: | |
| Online Access: | http://www.jfmpc.com/article.asp?issn=2249-4863;year=2020;volume=9;issue=7;spage=3634;epage=3638;aulast=Nosrati |
| _version_ | 1811223823051128832 |
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| author | Marzieh Nosrati Nikinaz Ashrafi Shahmirzadi Monireh Afzali Pardis Zaboli Hasti Rouhani Haleh Hamedifar Mirhamed Hajimiri |
| author_facet | Marzieh Nosrati Nikinaz Ashrafi Shahmirzadi Monireh Afzali Pardis Zaboli Hasti Rouhani Haleh Hamedifar Mirhamed Hajimiri |
| author_sort | Marzieh Nosrati |
| collection | DOAJ |
| description | Objective: Endothelin (ET) receptor antagonists (ERAs) have considerable improvements in pulmonary arterial hypertension (PAH) patients’ symptoms. Macitentan, a novel ERA, has more significant positive effects like reduction of morbidity and mortality in PAH patients by 45% and decreases PAH hospitalization. Besides, macitentan was able to improve both the physical and mental aspects of patients’ lives. This study aimed to evaluate an incremental cost-utility analysis of macitentan compared with bosentan in PAH patients in the Iranian health care system. Methods: We developed a hybrid model consisting of a decision tree in which PAH patients would take and continue either macitentan or bosentan with different probabilities. Subsequently, each patient would enter one of the 4 Markov's, each consisting of 5 states, PAH fraction I, PAH fraction II, PAH fraction III, PAH fraction IV, and death. The cycles and time horizon were considered 3 months and lifetime, respectively. We assessed the impact of each medicine on patients’ quality-adjusted life-years (QALYs) and costs, consequently calculated the ICER (Incremental Cost-Effectiveness Ratio). The costs were measured in the dollar (1 dollar is equal to 42000 rials) with the perspective of the payer. The discount rates were assumed 3% for utility and 5% for costs. In addition, a sensitivity analysis was conducted. Results: The costs are about 14163 dollars for bosentan and 13876 dollars for macitentan for each patient in a lifetime. The QALY produced per patient by macitentan was 0.81 more than that of bosentan. The calculated ICER was -357.47 which means that for each incremental QALY, the payer is charged less. Conclusion: Macitentan is preferable to and dominant over bosentan in both effectiveness and expenditure. Thus, the therapeutic regimen containing macitentan is introduced as a favorable treatment strategy. |
| first_indexed | 2024-04-12T08:40:03Z |
| format | Article |
| id | doaj.art-dc803848edfb428d9b01895b81aa4ba5 |
| institution | Directory Open Access Journal |
| issn | 2249-4863 |
| language | English |
| last_indexed | 2024-04-12T08:40:03Z |
| publishDate | 2020-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Family Medicine and Primary Care |
| spelling | doaj.art-dc803848edfb428d9b01895b81aa4ba52022-12-22T03:39:56ZengWolters Kluwer Medknow PublicationsJournal of Family Medicine and Primary Care2249-48632020-01-01973634363810.4103/jfmpc.jfmpc_1166_19Cost-utility analysis of Macitentan Vs. Bosentan in pulmonary atrial hypertensionMarzieh NosratiNikinaz Ashrafi ShahmirzadiMonireh AfzaliPardis ZaboliHasti RouhaniHaleh HamedifarMirhamed HajimiriObjective: Endothelin (ET) receptor antagonists (ERAs) have considerable improvements in pulmonary arterial hypertension (PAH) patients’ symptoms. Macitentan, a novel ERA, has more significant positive effects like reduction of morbidity and mortality in PAH patients by 45% and decreases PAH hospitalization. Besides, macitentan was able to improve both the physical and mental aspects of patients’ lives. This study aimed to evaluate an incremental cost-utility analysis of macitentan compared with bosentan in PAH patients in the Iranian health care system. Methods: We developed a hybrid model consisting of a decision tree in which PAH patients would take and continue either macitentan or bosentan with different probabilities. Subsequently, each patient would enter one of the 4 Markov's, each consisting of 5 states, PAH fraction I, PAH fraction II, PAH fraction III, PAH fraction IV, and death. The cycles and time horizon were considered 3 months and lifetime, respectively. We assessed the impact of each medicine on patients’ quality-adjusted life-years (QALYs) and costs, consequently calculated the ICER (Incremental Cost-Effectiveness Ratio). The costs were measured in the dollar (1 dollar is equal to 42000 rials) with the perspective of the payer. The discount rates were assumed 3% for utility and 5% for costs. In addition, a sensitivity analysis was conducted. Results: The costs are about 14163 dollars for bosentan and 13876 dollars for macitentan for each patient in a lifetime. The QALY produced per patient by macitentan was 0.81 more than that of bosentan. The calculated ICER was -357.47 which means that for each incremental QALY, the payer is charged less. Conclusion: Macitentan is preferable to and dominant over bosentan in both effectiveness and expenditure. Thus, the therapeutic regimen containing macitentan is introduced as a favorable treatment strategy.http://www.jfmpc.com/article.asp?issn=2249-4863;year=2020;volume=9;issue=7;spage=3634;epage=3638;aulast=Nosraticost-effectivenesseconomic evaluationendothelin receptor antagonistsmarkovquality-adjusted life yearssensitivity analysis |
| spellingShingle | Marzieh Nosrati Nikinaz Ashrafi Shahmirzadi Monireh Afzali Pardis Zaboli Hasti Rouhani Haleh Hamedifar Mirhamed Hajimiri Cost-utility analysis of Macitentan Vs. Bosentan in pulmonary atrial hypertension Journal of Family Medicine and Primary Care cost-effectiveness economic evaluation endothelin receptor antagonists markov quality-adjusted life years sensitivity analysis |
| title | Cost-utility analysis of Macitentan Vs. Bosentan in pulmonary atrial hypertension |
| title_full | Cost-utility analysis of Macitentan Vs. Bosentan in pulmonary atrial hypertension |
| title_fullStr | Cost-utility analysis of Macitentan Vs. Bosentan in pulmonary atrial hypertension |
| title_full_unstemmed | Cost-utility analysis of Macitentan Vs. Bosentan in pulmonary atrial hypertension |
| title_short | Cost-utility analysis of Macitentan Vs. Bosentan in pulmonary atrial hypertension |
| title_sort | cost utility analysis of macitentan vs bosentan in pulmonary atrial hypertension |
| topic | cost-effectiveness economic evaluation endothelin receptor antagonists markov quality-adjusted life years sensitivity analysis |
| url | http://www.jfmpc.com/article.asp?issn=2249-4863;year=2020;volume=9;issue=7;spage=3634;epage=3638;aulast=Nosrati |
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