Treatment of pulmonary arterial hypertension (PAH) with Tracleer (bosentan) may be more cost-effective than epoprostenol medications or palliative care, but less than Revatio (sildenafil) and other endothelin receptor blockers, a review study suggests.
The study, “Cost Effectiveness of Bosentan for Pulmonary Arterial Hypertension: A Systematic Review,” was published in the Canadian Respiratory Journal.
Several medications with different mechanisms of action to treat PAH have been approved in the past 20 years. An evaluation of their economic and long-term health impacts is important in determining which treatments are cost-effective.
Extensive studies have been done on the efficacy and costs of Actelion Pharmaceuticals’ Tracleer, an inhibitor of ETA and ETB endothelin receptors, directed at helping the vessels relax and increasing blood flow to the lungs. Given the ongoing discussion of Tracleer’s high price, a team from the Huazhong University of Science and Technology in China evaluated the therapy’s economic impact in PAH.
This report was meant to better understand what drives Tracleer’s cost-effectiveness to help better inform healthcare decision-makers and patients.
A total of seven online databases — four in English and three in Chinese — were screened between January 2000 and June 2017. A total of eight studies were included, all with a full economic evaluation, including cost-effectiveness and cost-utility ratios. The studies looked at Tracleer as a stand-alone or combination therapy.
“This is the most comprehensive review incorporating economic evaluations over an extended period of time,” the researchers wrote.
Two studies compared Tracleer with prostanoid medications for PAH treatment: epoprostenol (sold under the brand names Flolan by GlaxoSmithKline, and Veletri by Actelion) and treprostinil (brand names Tyvaso, Remodulin, and Orenitram, all from United Therapeutics).
One of these studies found that, in 2017, Tracleer was more cost-effective than both epoprostenol, by a savings of $46,417.21, and treprostinil, by a savings of $62,289.22. Tracleer also offered more quality-adjusted life-years (QALYs) per patient — QALYs measure the benefits in length of life, adjusted to reflect quality of life.
In contrast, the other study — partially funded by Actelion, Gilead, United Therapeutics, and Pfizer — reported that treatment with treprostinil in 2017 resulted in an average savings of $4,818.51 when used instead of Tracleer.
In the four studies — two of which were funded by GlaxoSmithKline — comparing Tracleer with other endothelin receptor blockers, the scientists found that Letairis (ambrisentan), marketed by Gilead in the U.S. and GlaxoSmithKline in Europe, saved up to $1.1 million over three years. The two studies that compared Tracleer with Pfizer’s Revatio found lower costs and similar or greater QALYs with Revatio in the U.S. and Canada.
In addition, the four studies assessing Tracleer’s cost-effectiveness compared with conventional supportive, or palliative therapy did not show consistent results. Two Actelion-sponsored studies did report improvements in life expectancy, lower costs, and better outcomes in QALYs over palliative care.
“Based on the available evidence, we conclude that the administration of [Tracleer] for PAH appears to be a more cost-effective alternative compared with epoprostenol and conventional or palliative therapy,” the researchers wrote. But Tracleer “was not a cost-effective front-line therapy compared with [Revatio] and other endothelin receptor antagonists.”
Among the study’s limitations, the investigators noted the diverse methodologies, and that some findings did not represent all PAH patients in a real-world setting.
As a result, “high-quality cost-effectiveness analyses that utilize long-term follow-up data and have no conflicts of interest are still needed,” they concluded.