Key result
Initial combination therapy for incident PAH patients reduced the number of hospitalizations by 101 over 3 years, resulting in a slight cost saving of €16,070 for the Italian NHS compared to monotherapy.
Why the study?
Does initial combination therapy compared to monotherapy reduce healthcare costs and hospitalizations in incident patients with PAH WHO FC II or III?
Does initial combination therapy compared to monotherapy reduce healthcare costs and hospitalizations in incident patients with PAH WHO FC II or III?
Effect estimate: Difference of -€16,070
Absolute Event Rate: 34542152% vs 34558222%
Initial combination therapy for PAH WHO FC II or III is projected to be cost-neutral or cost-saving for the Italian healthcare system due to a significant reduction in hospitalizations.
May support initial combination therapy to cut PAH hospitalizations; leaves open prospective confirmation of net savings.
Background: Initial combination therapy in patients with pulmonary arterial hypertension (PAH) WHO functional class (FC) II or III has demonstrated clinical benefits over initial monotherapy. The objective of this study is to compare the financial impact of initial combination therapy with initial monotherapy for incident patients with PAH in Italy.Methods: A 3-year budget impact model compared a ‘status quo’ scenario of initial monotherapy with an endothelin receptor antagonist (ERA), phosphodiesterase 5 inhibitor (PDE5i) or prostanoid, with a ‘new’ scenario involving initial combination therapy, using Italian national healthcare system (NHS) data for incident patients with PAH WHO FC II or III. The hospitalisation hazard ratio (HHR) from the AMBITION study and expert panel advice on therapy use were employed. Univariate sensitivity analyses were performed.Results: A difference in costs of €16,070 favouring the ‘new’ scenario (initial combination therapy) was observed, and attributed to 101 fewer hospitalisations over 3 years. Sensitivity analyses showed that costs were driven by the proportion of patients receiving ERAs versus PDE5i, hospitalisation costs and prostanoid dose.Conclusion: Initial combination therapy instead of monotherapy could reduce the number and cost of hospitalisations without an increase in the total costs to the Italian NHS.
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Barbieri et al. (2017) studied Pulmonary arterial hypertension (PAH) WHO FC II or III. Initial combination therapy vs. Initial monotherapy (ERA, PDE5i, or prostanoid) was evaluated on Total costs to the Italian NHS over 3 years (Difference of -€16,070). Initial combination therapy for incident PAH patients reduced the number of hospitalizations by 101 over 3 years, resulting in a slight cost saving of €16,070 for the Italian NHS compared to monotherapy.
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