VILLA, Guillermo; MORANO, Raúl; ROMAN, Antonio    GII, Joan. Efficiency of initiation with ambrisentan versus bosentan in the treatment of pulmonary arterial hypertension. []. , 37, 5, pp.358-365. ISSN 2171-8695.  https://dx.doi.org/10.7399/FH.2013.37.5.736.

Objective: To evaluate the efficiency of initiation with endothelin receptor antagonists, ambrisentan or bosentan, followed by sequential combination with phosphodiesterase-5 inhibitors and prostanoids in the treatment of pulmonary arterial hypertension, from the Spanish National Health System perspective. Methods: A Markov model was developed based on the four New York Heart Association functional classes. A panel of three experts reached a consensus on patient management based on clinical practice. Patients revised their treatment every 12 weeks, based on their health status and previous medication records. Pharmacological treatment costs and costs associated with very frequent adverse events (AE) were considered in a horizon of 60 weeks. Outcomes were measured in quality-adjusted life years (QALY). A probabilistic sensitivity analysis was performed. Results: No clinically relevant differences in QALY per-patient and year were found for initiation with ambrisentan and bosentan: 0.6853 and 0.6902, respectively. Initiation with ambrisentan resulted in lower pharmacological treatment and AE management costs: €35,550 and € 117 versus €40,224 and € 171. In the sensitivity analysis, initiation with ambrisentan resulted in a negative significant cost difference: €-4,982; CI95%[€-8,014; €-2,500]; while no significant differences in QALY were found: -0.0044; CI95%[-0.0189; 0.0101]. Conclusions: Initiation with ambrisentan followed by sequential combination with phosphodiesterase-5 inhibitors and prostanoids yields comparable outcomes at lower costs than initiation with bosentan.

: Pulmonary arterial hypertension; Pharmacoeconomics; Economic models.

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