OBJECTIVES

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, progressive condition associated with high morbidity, mortality, and economic burden. Currently, riociguat is the only medication licensed for patients with inoperable CTEPH. However, macitentan is being studied for this indication. This analysis investigates the potential budgetary impact of the market entrance of macitentan compared to riociquat for inoperable CTEPH.

METHODS

A treatment-eligible population consisting of adults with inoperable CTEPH was estimated, using prevalence rate (0.0043%), percent of patients diagnosed (16% to 22% from year 1 to 3), and percent of diagnosed patients with inoperable disease (36.4%). Two market scenarios were analyzed: 1) Current Market Scenario with riociguat only and 2) New Market Scenario with both riociguat and macitentan available for CTEPH. Drug costs were based on WAC prices and dosing from the published medical literature for each product.

RESULTS

For a 100-million-member plan, the estimated numbers of CTEPH-treated patients were 250, 282, and 344 over 3 years. In the potential new market scenario, the market share of riociguat decreased from 100% to 54%, while the market of macitentan increased from 0 to 46%. For years one to three, this change resulted in an estimated annual budget savings of $1.0, $1.2, and $1.4 million which corresponded to a per member per month (PMPM) savings of $0.00085, $0.00096, and $0.00117.

CONCLUSIONS

The addition of macitentan for the treatment of inoperable CTEPH is expected to be cost saving for the budget of a health plan. This is due to the slight cost benefit of macitentan compared to riociguat and the low prevalence of CTEPH.