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. 2023 Aug 11:14:1122866.
doi: 10.3389/fphar.2023.1122866. eCollection 2023.

Cost-effectiveness analysis of selexipag for the combined treatment of pulmonary arterial hypertension

Wenxing Dong  1   2 , Zhe Zhang  1 , Mingming Chu  1 , Peng Gu  1 , Min Hu  1 , Lulu Liu  1 , Jingbin Huang  1 , Rong Zhang  1
Affiliations

Cost-effectiveness analysis of selexipag for the combined treatment of pulmonary arterial hypertension

Wenxing Dong et al. Front Pharmacol. .

Abstract

Objective: Adding selexipag to the combined treatment of endothelin receptor antagonists (ERA) and phosphodiesterase 5 inhibitor (PDE5i) reduces the risk of clinical worsening events in patients with pulmonary arterial hypertension (PAH) but at a considerably higher cost. This study evaluated the cost-effectiveness of adding selexipag to the combined treatment of ERA and PDE5i in patients with PAH from a Chinese healthcare system perspective. Methods: A Markov model was developed to assess costs and quality-adjusted life years (QALYs) of macitentan + tadalafil + selexipag vs. macitentan + tadalafil for the treatment of PAH. Markov states included WHO Functional Class (FC) (I-IV) and death. Transition probabilities were based on data from the TRITON trial. Mortality rates, costs, and utilities were obtained from published literature and public databases. Results: In the base case analysis, compared with macitentan + tadalafil, selexipag + macitentan + tadalafil increased costs ($357,807.588 vs. $116,534.543, respectively) and QALYs (7.234 QALYs vs. 6.666 QALYs, respectively). The resulting incremental cost-effectiveness ratio was $424,746.070 per QALY, which was higher than the willingness-to-pay (WTP) of $38,223.339 per QALY. The results were most sensitive to HR for mortality of patients with FC IV relative to the general population, discount rate, and the cost of selexipag. The probability was greater than 50% for the selexipag + macitentan + tadalafil only if the WTP was more significant than $426,019.200 per QALY. Conclusion: In China, adding selexipag may not be cost-effective for patients with PAH who failed to control their condition after combined treatment of ERA and PDE5i. Results of the analysis can aid discussions on the value and position of selexipag for the combined treatment of PAH.

Keywords: cost-effectiveness; endothelin receptor antagonists; markov model; phosphodiesterase 5 inhibitor; pulmonary arterial hypertension; selexipag.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Markov models of the (A) first and (B) subsequent cycles. Each circle represents a state, lines and arrows represent transition directions between states. Patients can be in only one health state per cycle. FC, functional class.
FIGURE 2
FIGURE 2
The tornado diagram of univariable sensitivity analyses shows the effect on ICER as each variable varies within its range. The vertical gray line represents the value of ICER in the base-case analysis. The blue bar indicates that the ICER increases as parameter values decrease, and the red bar represents that the ICER decreases as parameter values increase. Dual, macitentan + tadalafil; triple, selexipag + macitentan + tadalafil; FC, functional class; HR, hazard ratio; ICER, incremental cost-effectiveness ratio.
FIGURE 3
FIGURE 3
The scatterplot depicts the results of the Monte Carlo analysis. The black dots show 5,000 iterations, and the dashed line indicates the preset WTP. WTP, willingness-to-pay.
FIGURE 4
FIGURE 4
The cost-effectiveness acceptability curve indicates the probability of cost-effectiveness at different WTP thresholds based on the uncertainty of the parameters after 5,000 Monte Carlo simulations. The line consisting of circles demonstrates the strategy of macitentan + tadalafil, and the line consisting of triangles shows the strategy of selexipag + macitentan + tadalafil. The vertical dash lines indicate various WTP values. QALY, quality-adjusted life year; WTP, willingness-to-pay.
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