OBJECTIVES: Treprostinil is a prostacyclin analogue indicated for the treatment of pulmonary arterial hypertension (PAH). A recent retrospective study analyzed the drug safety events of treprostinil and showed that higher doses were associated with lower hospitalization rates compared to lower doses. This analysis aims to estimate annual PAH-related hospitalization costs in patients treated with low, medium and high treprostinil doses in nine European countries (Belgium, France, Germany, Italy, Poland, Portugal, Spain, the Netherlands and the United Kingdom).

METHODS: A cost model was developed to calculate hospitalization costs in patients with PAH who were treated with treprostinil at different doses: low (<4.0 mg/day and <8.3 ng/kg/min), medium (4.0-9.0 mg/day and 8.3-30 ng/kg/min) and high (>9.0 mg/day and >30 ng/kg/min) for oral and subcutaneous treprostinil, respectively. Mean annual hospitalization costs per country were calculated using annual PAH-related hospitalization rates per dose and unit costs (euros, 2021) from national databases or published literature. When not available, heart failure-related costs were considered. Subgroup analyses were performed by gender, disease etiology, and WHO functional class (FC).

RESULTS: Mean annual PAH-related hospitalization costs for the overall population were €1,507 (€858-2,794), €2,110 (€1,201-3,912) and €4,571 (€2,601-8,476) for high, medium and low dose, respectively, across all analyzed countries. Thus, hospitalization costs for high-dose patients were approximately 3 times lower than low-dose patients and 1.4 times lower than medium-dose patients. Results were consistent across subgroups, leading to cost savings in both genders, all etiologies (idiopathic or familial, collagen vascular disease and others), and WHO FC II and III. The greatest differences were observed between high and low-dose, in male subgroup (€1,115-3,632 vs. €4,431-14,436), idiopathic or familial (€743-2,422 vs. €2,658-8,662) and WHO FC III (€858-2,794 vs. €2,544-8,289).

CONCLUSIONS: Patients with higher doses of treprostinil resulted in lower hospitalization costs in comparison to those in lower doses, consistently across subgroups in the analyzed European settings.