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ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 7  |  Page : 3634-3638

Cost-utility analysis of Macitentan Vs. Bosentan in pulmonary atrial hypertension


1 Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran; CinnaGen Medical Biotechnology Research Center, Alborz University of Medical Sciences, Karaj; NanoAlvand Co., Avicenna Tech Park, Tehran University of Medical Sciences, Tehran, Iran
3 Drug Selection Committee, Iranian Food and Drug Organization, Iran Ministry of Health, Tehran, Iran
4 CinnaGen Medical Biotechnology Research Center, Alborz University of Medical Sciences, Karaj; NanoAlvand Co., Avicenna Tech Park, Tehran University of Medical Sciences, Tehran, Iran
5 CinnaGen Medical Biotechnology Research Center, Alborz University of Medical Sciences, Karaj, Iran

Correspondence Address:
Dr. Mirhamed Hajimiri
CinnaGen Medical Biotechnology Research Center, Alborz University of Medical Sciences, Karaj
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_1166_19

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Objective: Endothelin (ET) receptor antagonists (ERAs) have considerable improvements in pulmonary arterial hypertension (PAH) patients’ symptoms. Macitentan, a novel ERA, has more significant positive effects like reduction of morbidity and mortality in PAH patients by 45% and decreases PAH hospitalization. Besides, macitentan was able to improve both the physical and mental aspects of patients’ lives. This study aimed to evaluate an incremental cost-utility analysis of macitentan compared with bosentan in PAH patients in the Iranian health care system. Methods: We developed a hybrid model consisting of a decision tree in which PAH patients would take and continue either macitentan or bosentan with different probabilities. Subsequently, each patient would enter one of the 4 Markov's, each consisting of 5 states, PAH fraction I, PAH fraction II, PAH fraction III, PAH fraction IV, and death. The cycles and time horizon were considered 3 months and lifetime, respectively. We assessed the impact of each medicine on patients’ quality-adjusted life-years (QALYs) and costs, consequently calculated the ICER (Incremental Cost-Effectiveness Ratio). The costs were measured in the dollar (1 dollar is equal to 42000 rials) with the perspective of the payer. The discount rates were assumed 3% for utility and 5% for costs. In addition, a sensitivity analysis was conducted. Results: The costs are about 14163 dollars for bosentan and 13876 dollars for macitentan for each patient in a lifetime. The QALY produced per patient by macitentan was 0.81 more than that of bosentan. The calculated ICER was -357.47 which means that for each incremental QALY, the payer is charged less. Conclusion: Macitentan is preferable to and dominant over bosentan in both effectiveness and expenditure. Thus, the therapeutic regimen containing macitentan is introduced as a favorable treatment strategy.


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