OBJECTIVES

Endothelin (ET) receptor antagonists (ERAs), have considerable improvements on PAH patients’ symptoms. Macitentan, a novel ERA, has more significant positive effects like reduction of morbidity and mortality in PAH patients by 45% and decrease PAH hospitalization. Besides, Macitentan was able to improve both physical and mental aspects of patients’ lives. The aim of this study was to evaluate an incremental cost utility analysis of Macitentan compared with Bosentan in PAH patients in Iranian health care system.

METHODS

We developed a hybrid model consisted 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 Markovs, 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 life time, 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 dollar (1 dollar is equal to 42000 rials) with the perspective of payer. The discount rates were assumed 3% for utility and 5% for costs. Also, sensitivity analysis was conducted.

RESULTS

The costs are about 14163 dollars for Bosentan and 13876 dollars for Macitentan for each patient life time. The QALY produced per patient by Macitentan was 0.81 more than that of Bosentan. The calculated ICER was -15013959.37 which means that for each incremental QALY, the payer is charged less.

CONCLUSIONS

Macitentan is preferable to and dominant over Bosentan in both effectiveness and expenditure. Thus, therapeutic regimen containing Macitentan is introduced as a favorable treatment strategy.