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Public Funding of Bosentan for the Treatment of Pulmonary Artery Hypertension in Australia

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  • John Wlodarczyk
  • Leslie Cleland
  • Anne Keogh
  • Keith McNeil
  • Kate Perl
  • Robert Weintraub
  • Trevor Williams

Abstract

Objectives: In Australia, no therapeutic agents were subsidised for the treatment of idiopathic pulmonary artery hypertension (iPAH), a rare progressive and severe disease with short life expectancy, until 1 March 2004, when bosentan (a dual endothelin receptor antagonist of high cost) was listed on the Pharmaceutical Benefits Scheme (PBS). Bosentan, in addition to conventional therapy, has been shown to slow iPAH progression and improve clinical and haemodynamic status and symptomatology, compared with placebo and conventional therapy. The objective of this paper is to describe the process of the Australian Pharmaceutical Benefits Scheme listing for bosentan (Tracleer®), which included a health economic model assessing the cost effectiveness of bosentan from a healthcare payer perspective, and a risk-sharing arrangement based on the establishment of a patient registry. Methods: The health economic model predicted the cost, hospitalisation and mortality rates of a population of iPAH patients treated with either the conventional therapy regimen used in Australia or bosentan plus the conventional therapy regimen. The model was implemented as a first-order Monte Carlo simulation with mortality modelled directly as the main clinical outcome. The impacts of proposed continuation criteria, restricting the ongoing use of the drug, were evaluated. Costs and outcomes were discounted at 5% and a sensitivity analysis examined the robustness of the key assumptions. Results: The model predicted that after 5, 10 and 15 years, the difference in average cumulative costs between bosentan plus conventional therapy and conventional therapy alone would be 116 929 Australian dollars ($A), $A181 808 and $A216 331 for each patient, respectively. There would be an associated increase in average life expectancy of 1.39, 2.93 and 3.87 years at 5, 10 and 15 years, respectively, with an incremental cost-effectiveness ratio at 15 years of $A55 927 for each life-year gained. Removing the continuation criteria from the model increased the incremental cost-effectiveness ratio to $A62 267 (1996–2002 values). Conclusions: Economic modelling based on improved survival suggests bosentan to be a potentially cost-effective treatment for iPAH. However, the structure of the model and its inputs should be reviewed and updated as more data become available. Copyright Adis Data Information BV 2006

Suggested Citation

  • John Wlodarczyk & Leslie Cleland & Anne Keogh & Keith McNeil & Kate Perl & Robert Weintraub & Trevor Williams, 2006. "Public Funding of Bosentan for the Treatment of Pulmonary Artery Hypertension in Australia," PharmacoEconomics, Springer, vol. 24(9), pages 903-915, September.
  • Handle: RePEc:spr:pharme:v:24:y:2006:i:9:p:903-915
    DOI: 10.2165/00019053-200624090-00007
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    Cited by:

    1. Antonio Roman & Joan Barberà & Pilar Escribano & Maria Sala & Laia Febrer & Itziar Oyagüez & Eliazar Sabater & Miguel Casado, 2012. "Cost effectiveness of prostacyclins in pulmonary arterial hypertension," Applied Health Economics and Health Policy, Springer, vol. 10(3), pages 175-188, May.
    2. Simon Walker & Mark Sculpher & Karl Claxton & Steve Palmer, 2012. "Coverage with evidence development, only in research, risk sharing or patient access scheme? A framework for coverage decisions," Working Papers 077cherp, Centre for Health Economics, University of York.
    3. Carlson, Josh J. & Sullivan, Sean D. & Garrison, Louis P. & Neumann, Peter J. & Veenstra, David L., 2010. "Linking payment to health outcomes: A taxonomy and examination of performance-based reimbursement schemes between healthcare payers and manufacturers," Health Policy, Elsevier, vol. 96(3), pages 179-190, August.
    4. Lou Garrison;Ruth Puig-Peiro;Adrian Towse, 2012. "The Use of Pay-for-Performance for Drugs: Can It Improve Incentives for Innovation?," Occasional Paper 000167, Office of Health Economics.
    5. Antonio Roman & Joan A. Barberà & Pilar Escribano & Maria L. Sala & Laia Febrer & Itziar Oyagüez & Eliazar Sabater & Miguel Á. Casado, 2012. "Cost effectiveness of prostacyclins in pulmonary arterial hypertension," Applied Health Economics and Health Policy, Springer, vol. 10(3), pages 175-188, May.
    6. George Dranitsaris & Sanjay Mehta, 2009. "Oral therapies for the treatment of pulmonary arterial hypertension," Applied Health Economics and Health Policy, Springer, vol. 7(1), pages 43-59, March.

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