Pharmacoeconomic evidence of bosentan for pulmonary arterial hypertension

Abstract

In this article, we review randomized controlled trials, open-label trials and pharmacoeconomic models of bosentan for the management of patients with pulmonary arterial hypertension. Bosentan consistently improves WHO functional class and quality of life, slows clinical worsening and is associated with improved survival compared with historical treatment. Although head-to-head trials are scarce, data directly comparing bosentan with sildenafil indicate no clinically significant differences between treatments as measured by the 6-min walk distance alone. Compared with historical care, bosentan treatment, over a 15–30-year period, increases the number of quality-adjusted life years (3.49 years). Economic modeling suggests that the cost–effectiveness of bosentan is similar to that of ambrisentan (US$43,725–57,778 per quality-adjusted life year), not as cost effective as sildenafil (at 20 mg three-times daily) and more cost effective than iloprost. More randomized controlled trials of longer duration are required to confirm the results from these economic models.

Keywords::

• cost–effectiveness
• endothelin receptor antagonists
• incremental cost–effectiveness ratio
• phosphodiesterase inhibitors
• pulmonary arterial hypertension
• quality-adjusted life years

Financial & competing interests disclosure

Anne Keogh has received research grants, honoraria and is on Advisory Boards for Actelion, Bayer, GSK, Pfizer and Novartis. Brad Dalton has received consultancy fees from Actelion. Eli Gabbay has received research grants. honoraria and is on Advisory Boards for Actelion, Pfizer, Bayer and GSK. Geoff Strange has no conflicts of interest to declare. All authors contributed to writing the manuscript. 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.

No writing assistance was utilized in the production of this manuscript.