Systematic Review of Economic Evaluation of Drug Treatments in Pulmonary Arterial Hypertension (PAH)

Pulmonary arterial hypertension (PAH) is a rare disease but PAH treatment cost is very high. Nowadays, there has been no cost-effectiveness information related to PAH treatments in Thailand. The aim of this study was to systematically review economic evaluation studies of drugs treatment in PAH. Studies reporting in term of clinical outcomes and costs during January 1990 to October 2012 were searched through PubMed and Cochrane databases. Seventeen articles were reviewed and only six full text articles were included. Six studies were conducted in developed countries. Populations in most studies were not specific to any type of PAH. Perspectives in all studies were healthcare payer and healthcare system. Compared interventions included sildenafil, iloprost and bosentan. Time horizon was either short-term or long-term period. Most studies used Markov model approach. Costs were estimated according to the perspective of study. Costs were discounted at different rates in each study. In term of clinical effectiveness, most studies showed that bosentan and sildenafil had more effective than iloprost. Sensitivity analyses were performed in all studies. Most studies showed that bosentan and sildenafil had lower cost and higher quality-adjusted life year (QALYs) gained compared to other drugs. The results of this systematic review suggested that drug treatments for PAH would be cost-effective in developed countries. However, the costeffectiveness analysis of drug treatments for PAH should be further investigated in Thailand due to a difference in socioeconomic infrastructure from developed countries. Key word: Economic Evaluation, Pulmonary arterial hypertension, Pulmonary artery hypertension, Systematic review, Drug treatments for PAH