Orenitram Tablets More Cost-effective Than Uptravi as PAH Treatment, Study Suggests

Treatment with Orenitram (oral treprostinil) is associated with lower healthcare-related costs than treatment with Uptravi (selexipag) in people with pulmonary arterial hypertension (PAH), a new study suggests.

The study, “Medication Adherence and Healthcare Costs Among Patients with Pulmonary Arterial Hypertension Treated with Oral Prostacyclins: A Retrospective Cohort Study,” was published in the journal Drugs – Real World Outcomes.

Prostacyclin is a hormone that relaxes blood vessels, causing them to widen and consequently lower blood pressure. Oral therapies that mimic the action of this hormone, including Orenitram (marketed by United Therapeutics) and Uptravi (marketed by Actelion, part of the Johnson & Johnson family of companies), have become common treatments for PAH in recent years.

Although the safety and efficacy of these therapies is well-established, the relative costs associated with them have not been thoroughly examined.

Thus, a team including researchers at Xcenda and United Therapeutics (which funded the study) analyzed insurance data from the IBM MarketScan databases.

By analyzing relevant codes, the team identified 130 people with PAH who had been treated with Orenitram, and 126 who had been treated with Uptravi, between 2014 and 2017. For all these individuals, data was analyzed for the six months before and after being prescribed the respective medication.

The two groups were similar in terms of demographic features, including age (average of about 58 years in both groups), and place of residence (all in the United States, slightly more from the southern states than from other regions). There was a greater percentage of males in the Orenitram group (33.1% vs. 16.7% in the Uptravi group).

Before beginning either treatment, baseline total healthcare costs were similar between the two groups.

Medication adherence was examined by calculating the medication possession ratio (MPR) and the proportion of days covered (PDC). Conceptually, they measure how often prescriptions were filled, as compared to how many days those prescriptions should cover. For example, if a person gets a 30-day refill every 45 days, their MPR and PDC would be low, reflecting a low treatment adherence.

A slight, though statistically significant, higher MPR was found for Orenitram than Uptravi (0.89 vs. 0.85); PDC did not differ significantly between the groups.

“[M]edication adherence and persistence with oral prostacyclin therapies were similar in the cohorts,” the researchers wrote.

The team also examined hospital visits, and found no difference in number or length of inpatient visits (overnight hospital stays), or in emergency department visits. There was a slight, but significant, higher number of outpatient visits in the Orenitram group (average 22.0 vs. 18.8 in Uptravi group).

“Medical care utilization was similar between the study cohorts receiving oral prostacyclin therapies. Notably, both cohorts reported similar hospitalization rates,” the researchers wrote.

The team then looked at healthcare costs in both groups. After statistical adjustment for other variables (age, sex, region, insurance plan type, etc.), Orenitram was associated with 51.4% lower costs, corresponding to a difference of about $73,680. This was driven primarily by differences in pharmacy costs, which were 68.2% lower in the Orenitram group.

“Given that all [healthcare resource use], except for the number of outpatient visits, were similar between the cohorts during the post-index period and relatively similar at baseline, the higher overall healthcare cost can be attributed to treatment with selexipag,” the researchers wrote.

The team noted that this is likely attributable to differences in how dosages are priced: Uptravi uses a fixed-price model, where the same price is paid regardless of medication dose. Orenitram price varies depending on the dosage.

“While fixed pricing, regardless of dosage, is often perceived as less costly and predictable, dose-based pricing can result in lower costs with dose reductions,” the researchers wrote. “This study showed that, for oral prostacyclin drugs used in patients with PAH, treprostinil dose-based pricing led to lower pharmacy costs than the fixed pricing associated with selexipag.”

Of note, the team emphasized that the sample size of the study was relatively small, and the study was conducted in the U.S., “so caution needs to be used while generalizing these results to other PAH populations.” Researchers also highlighted the need for further research looking at costs accrued over a longer period of time.

Despite these study limitations, the team said: “This study provides real-world evidence to suggest that, in patients with PAH, treatment with oral treprostinil may be more cost effective than selexipag over a 6- to 12-month period.”