Cost-effectiveness of riociguat and bosentan for the treatment of chronic thromboembolic pulmonary hypertension

OBJECTIVE: To conduct a cost-effectiveness analysis of riociguat and bosentan in the management of chronic thromboembolic pulmonary hypertension (CTEPH) from a United States payer perspective. METHODS: A Markov model was developed following the recommendations of the International Society of Pharmacoeconomics and Outcomes Research - Society for Medical Decision Making Modeling Good Research Practices. A cohort of patients with inoperable CTEPH or post-pulmonary endarterectomy CTEPH were simulated over their lifetime. Health outcomes were measured as quality-adjusted life years (QALY). Efficacy and safety data were obtained from BENEFiT and CHEST-1 trials. Drugs costs, associated costs for the management of CTEPH, were obtained from Redbook and published information such as the Healthcare Cost and Utilization Project (HCUPnet) and Centers for Medicare & Medicaid Services Physician Fee Schedule. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the model projections. RESULTS: Riociguat was more effective than bosentan with an incremental cost of $132,065 and an incremental quality-adjusted life year (QALY) of 0.20, corresponding to an incremental cost-effectiveness ratio (ICER) of -$649,380 per QALY (in favor of riociguat). Riociguat had a lower total discounted lifetime cost compared to bosentan ($2,307,488 versus$2,439,555). Probabilistic sensitivity analyses confirmed dominance of riociguat in 74% of the Monte Carlo simulations. CONCLUSIONS: Results of this model indicates that riociguat is more effective and less costly than bosentan in the management of patients with inoperable CTEPH or post-pulmonary endarterectomy CTEPH

Association Between CHADS2 Risk Factors and Anticoagulation-Related Bleeding: A Systematic Literature Review

OBJECTIVE: To determine the strength of evidence supporting an accentuated bleeding risk when patients with CHADS2 risk factors (chronic heart failure, hypertension, advanced age, diabetes, and prior stroke/transient ischemic attack) receive warfarin