TY - JOUR
T1 - Cost-effectiveness of combination therapy for patients with systemic sclerosis– related pulmonary arterial hypertension
AU - Tran-Duy, An
AU - Morrisroe, Kathleen
AU - Clarke, Philip
AU - Stevens, Wendy
AU - Proudman, Susanna
AU - Sahhar, Joanne
AU - Croyle, Lucy
AU - Ferdowsi, Nava
AU - Ngian, Gene Siew
AU - Strickland, Gemma
AU - Walker, Jennifer
AU - Nikpour, Mandana
AU - the Australian Scleroderma Interest Group (ASIG)
PY - 2021/4/6
Y1 - 2021/4/6
N2 - BACKGROUND: To evaluate the cost-effectiveness of combination pulmonary arterial hypertension specific therapy in systemic sclerosis–related PAH. METHODS AND RESULTS: Health outcomes and costs were captured through data linkage. Health utility was derived from Medical Outcomes Study Short Form-36 scores. A probabilistic discrete-time model was developed to simulate lifetime changes in costs and health utility. Mortality was predicted using a Gompertz parametric survival model. For both treatment arms, the simulations were started using the same cohort of 10 000 patients. Probabilistic sensitivity analysis was performed using the Monte Carlo simulation with 1000 sets of sampled parameter values. Of 143 patients with systemic sclerosis–related pulmonary arterial hypertension, 89 were on monotherapy and 54 on combination therapy. Mean simulated costs per patient per year in monotherapy and combination therapy groups were AU$23 411 (US$16 080) and AU$29 129 (US$19 982), re-spectively. Mean life years and quality-adjusted life years from pulmonary arterial hypertension diagnosis to death of patients receiving monotherapy were 7.1 and 3.0, respectively, and of those receiving combination therapy were 9.2 and 3.9, respec-tively. Incremental costs per life year and quality-adjusted life year gained of combination therapy compared with monotherapy were AU$47 989 (US$32 920) and AU$113 823 (US$78 082), respectively. At a willingness-to-pay threshold of AU$102 000 (US$69 972) per life year gained, and of AU$177 222 (US$121 574) per quality-adjusted life year gained, the probability of combination therapy being cost-effective was 0.95. CONCLUSIONS: The incremental cost per quality-adjusted life year gained of combination therapy compared with monotherapy was substantial in the base case analysis. Given the fatal prognosis of systemic sclerosis–related pulmonary arterial hypertension and the incremental cost per life year of AU$47 989 (US$32 920), combination therapy could be considered cost-effective in systemic sclerosis–related pulmonary arterial hypertension.
AB - BACKGROUND: To evaluate the cost-effectiveness of combination pulmonary arterial hypertension specific therapy in systemic sclerosis–related PAH. METHODS AND RESULTS: Health outcomes and costs were captured through data linkage. Health utility was derived from Medical Outcomes Study Short Form-36 scores. A probabilistic discrete-time model was developed to simulate lifetime changes in costs and health utility. Mortality was predicted using a Gompertz parametric survival model. For both treatment arms, the simulations were started using the same cohort of 10 000 patients. Probabilistic sensitivity analysis was performed using the Monte Carlo simulation with 1000 sets of sampled parameter values. Of 143 patients with systemic sclerosis–related pulmonary arterial hypertension, 89 were on monotherapy and 54 on combination therapy. Mean simulated costs per patient per year in monotherapy and combination therapy groups were AU$23 411 (US$16 080) and AU$29 129 (US$19 982), re-spectively. Mean life years and quality-adjusted life years from pulmonary arterial hypertension diagnosis to death of patients receiving monotherapy were 7.1 and 3.0, respectively, and of those receiving combination therapy were 9.2 and 3.9, respec-tively. Incremental costs per life year and quality-adjusted life year gained of combination therapy compared with monotherapy were AU$47 989 (US$32 920) and AU$113 823 (US$78 082), respectively. At a willingness-to-pay threshold of AU$102 000 (US$69 972) per life year gained, and of AU$177 222 (US$121 574) per quality-adjusted life year gained, the probability of combination therapy being cost-effective was 0.95. CONCLUSIONS: The incremental cost per quality-adjusted life year gained of combination therapy compared with monotherapy was substantial in the base case analysis. Given the fatal prognosis of systemic sclerosis–related pulmonary arterial hypertension and the incremental cost per life year of AU$47 989 (US$32 920), combination therapy could be considered cost-effective in systemic sclerosis–related pulmonary arterial hypertension.
KW - Cost-effectiveness analysis
KW - Pulmonary arterial hypertension
KW - Pulmonary vasodilator therapy
KW - Scleroderma
KW - Systemic sclerosis
UR - http://www.scopus.com/inward/record.url?scp=85104033546&partnerID=8YFLogxK
U2 - 10.1161/JAHA.119.015816
DO - 10.1161/JAHA.119.015816
M3 - Article
C2 - 33759539
AN - SCOPUS:85104033546
SN - 2047-9980
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 7
M1 - e015816
ER -
