Indirect treatment comparison and cost-minimization analysis of riociguat versus selexipag in patients with pulmonary arterial hypertension

ABSTRACT

Objectives

The comparative efficacy between riociguat and selexipag in patients with pulmonary arterial hypertension (PAH) has never been described in literature. Our aim was to prepare indirect treatment comparison (ITC) to evaluate the cost-effectiveness of riociguat in Czechia.

Methods

A systematic literature review identified two relevant trials with comparable endpoints to inform a Bucher ITC of relative and absolute effects. Given the comparable efficacy of riociguat and selexipag, a cost-minimization analysis (CMA) was conducted.

Results

A Bucher ITC provided evidence for the comparable relative efficacy of riociguat defined as the odds of unimproved functional class III 0.761 (95% CI 0.372 to 1.558; p = 0.455) compared to selexipag and a comparable absolute efficacy defined as a difference in the 6-minute walking distance of 10.560 meters (95% CI −10.692 to 31.812; p = 0.330). The CMA identified riociguat as the cost-saving therapy.

Conclusions

Switching to riociguat represents the cost-saving therapy for PAH patients who were inadequately compensated with the PDE5i+ERA therapy. Consequently, riociguat has been introduced to the list of reimbursed medicines in Czechia from October 2021. Based on two global trials, we prepared the first indirect treatment comparison followed with CMA of these therapies that may improve future decision-making for PAH indications.

KEYWORDS:

• Bucher indirect comparison
• cost-minimization analysis
• riociguat
• selexipag
• pulmonary arterial hypertension
• systematic review

Acknowledgments

We thank Thomas O. Secrest for proofreading and Verka Horackova for the graphics.

Declaration of interest

All authors are employees of Value Outcomes. Value Outcomes is a consultancy company working for the pharmaceutical industry in the field of market access, health economics, and outcomes research. T Dolezal is the director and owner of Value Outcomes. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors contributed to the concept, analysis, design, and material preparation and data collection. J Tuzil conducted the indirect comparison, cost-minimization analysis was performed by E Ornstova, and collection of inputs was done by all authors. K Chadimova wrote the first version of the manuscript, all authors commented on each version of the manuscript. All authors read and approved the final manuscript to be published. T Mlcoch and T Dolezal supervised the process and worked on the continuous revisions. E Ornstova and J Tuzil have the ultimate responsibility for the scientific integrity of the manuscript. J Tuzil, E Ornstova and T Mlcoch performed the systematic review.

Availability of data and material

The authors confirm that the data supporting the analysis findings are publicly available within the article, its supplementary materials, and the articles referenced in the manuscript.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2022.2126833

Additional information

Funding

The preparation of the present manuscript was not sponsored.