Cost-utility and budget impact analysis of drug treatments in pulmonary arterial hypertension associated with congenital heart diseases in Thailand

ABSTRACT

Objective: This study aims to compare the lifetime costs and health outcomes of both first-line and sequential combination treatments with standard treatment for pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD) (PAH-CHD) patients. Methods: A cost-utility analysis was performed using a Markov model based on a societal perspective. One-way and probabilistic sensitivity analyses were performed to investigate the effect of parameter uncertainty. Results: As first-line treatments, both beraprost (incremental cost-effectiveness ratio (ICER) = 192,752 and 201,308 Thai baht (THB) per quality-adjusted life year (QALY) gained) and sildenafil (ICER = 249,770 and 226,802 THB per QALY gained) seemed cost-effective for PAH-CHD patients aged ≤30 years in functional classes II and III, respectively, while no treatment was cost-effective for the sequential combination therapy. Conclusions: Sildenafil should be included in the National Drug List of Essential Medicines as the first-line treatment for PAH-CHD, and its price per dose should be negotiated to be reduced by 43–57%.

KEYWORDS:

• Cost-utility analysis
• pulmonary arterial hypertension
• congenital heart disease
• budget impact analysis
• Thailand

Acknowledgments

The authors would like to thank Assist. Prof. Dr. Tarinee Tangcharoen and Assoc. Prof. Dr. Suree Sompradeekul for their kind help in this study. They would also like to thank the Faculty of Pharmacy, Mahidol University, for research facilities as well as all staff and study participants at Ramathibodi Hospital and Siriraj Hospital, Mahidol University, who contributed to this study.

Financial & competing interests disclosure

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.