Table 1.
Transition probabilities, mortality rates, relative effects, costs and utilities by functional class and treatment
| Costs | ||
|---|---|---|
| Resource | Value | Reference |
| Monthly cost of PAH medications | ||
| Ambrisentan 5 mg or 10 mg once daily | $4028 | [26] |
| Bosentan 62.5–125 mg bid | $4219 | |
| Sildenafil 20 mg tid | $1099 | |
| Tadalafil 40 mg once daily | $881 | |
| Riociguat 1–2.5 mg tid | $4216 | |
| Epoprostenol (initiation: 2–27 ng/kg/min; subsequent: 27–50 ng/kg/min) | First 3 months: $1,758; subsequent months: $3,749 | |
| Average monitoring costs, per month (SE) | ||
| Ambrisentana | $16 (4.1) | [30] |
| Bosentanb | $26 (6.6) | |
| Epoprostenol specific costs (SE) | ||
| Initiation costsc | $9759 (2439.7) | [28, 29] |
| Infusion supply costs per day | $53 (13.25) | [25] |
| Cost to treat an episode of sepsis | $20,966 (5241) | [31] |
| Cost for replacement of CVC (every 2 years and due to infection) | $166 (41.5) | [29] |
| Average cost of supportive care medications, per monthd (SE) | ||
| Functional class II | $30 (7.5) | [44, 45] |
| Functional class III | $116 (28.9) | |
| Functional class IV | $287 (71.7) | |
| Functional class IV supportive care arm | $400 (99.9) | |
| Cost of continuing PAH care, per monthe (SE) | ||
| Functional class II | $228 (57.0) | [20, 29, 46] |
| Functional class III | $727 (181.9) | |
| Functional class IV | $2267 (566.7) | |
| Transition probabilities | ||
| Supportive care | ||
| Probability of FC improvement | 0.10 | [9] |
| Probability of FC worsening | 0.12 | |
| Relative risk of FC improvement versus supportive care (95 % CrI) | ||
| Ambrisentan 5 mg | 1.06 (0.61, 1.79) | [9]f |
| Ambrisentan 10 mg | 1.21 (0.62, 2.23) | |
| Bosentan | 2.05 (1.25, 3.32) | |
| Sildenafil | 3.71 (1.76, 7.29) | |
| Tadalafil | 2.67 (1.11, 5.76) | |
| Riociguat | 0.98 (0.45, 2.08) | |
| Epoprostenol | 9.42 (5.65, 17.48) | |
| Relative risk of functional class worsening versus supportive care (95 % CrI) | ||
| Ambrisentan 5 mg | 0.11 (0.03, 0.34) | [9]g |
| Ambrisentan 10 mg | 0.25 (0.05, 0.81) | |
| Bosentan | 0.46 (0.18, 1.04) | |
| Sildenafil | 0.27 (0.04, 1.10) | |
| Tadalafil | 0.45 (0.11, 1.44) | |
| Riociguat | 0.22 (0.07, 0.63) | |
| Epoprostenol | 0.40 (0.15, 0.93) | |
| Mortality rates | ||
| Relative risk of mortality versus FC I | ||
| Functional class II vs. FC I | 4.51 (1.37, 14.84) | [13] |
| Functional class III vs. FC I | 7.94 (2.53, 24.97) | |
| Functional class IV vs. FC I | 11.60 (3.68, 36.63) | |
| Increased risk of mortality with sepsis (per person month) | 0.000678 | [7] |
| Utilities | ||
| Functional class I | 0.73 (0.64, 0.82) | [23] |
| Functional class II | 0.67 (0.57, 0.77) | |
| Functional class III | 0.60 (0.50, 0.70) | |
| Functional class IV | 0.52 (0.43, 0.61) | |
| Disutility with sepsis, over 3 months | 0.108 | [24] |
CrI credible interval, PAH pulmonary arterial hypertension, bid twice daily, tid three times daily, CVC central venous catheter, SE standard error, NYHA New York Heart Association, FC functional class
All costs are expressed in Canadian dollars
aMonthly liver function tests and annual pregnancy test with ambrisentan
bMonthly liver function tests and monthly pregnancy tests with bosentan
cAssumed in 50 % of patients, epoprostenol is initiated within the hospital, and for 50 % through day surgery. Also includes training and CVC insertion costs
dWarfarin 5 mg daily in 53 % of patients, furosemide 100 mg daily in 69 % of patients, digoxin 0.125 mg daily in 26 % of patients, and home oxygen therapy in 5 % of patients with NYHA FC II, 27 % of patients with NYHA FC III and 71 % of patients with NYHA FC IV receiving PAH-specific therapies, and 100 % of patients with NYHA FC IV receiving supportive care
eIncludes general practitioner visits, specialist visits, nurse visits, hospitalizations, emergency room visits, and therapeutic procedures (echocardiograph and blood work)
fFixed effect model, naïve population network meta-analysis, Table 184, Appendix 11
gFixed effect model, naïve population network meta-analysis, Table 188, Appendix 11