PHARMAC responds on treatments for pulmonary arterial hypertension [5]

New Zealand Medical Journal

Volumn 118, Issue 1227, 2005, Pages

  Metcalfe, Scott ^a   Rasiah, Dilky ^a   Dougherty, Sean ^a  

^a PHARMAC ^*  (New Zealand)

Author keywords

[No Author keywords available]

Indexed keywords

BOSENTAN; CYCLOOXYGENASE 2 INHIBITOR; ILOPROST; SILDENAFIL;

AUSTRALIA; CLINICAL TRIAL; CONSULTATION; COST BENEFIT ANALYSIS; COST CONTROL; COST EFFECTIVENESS ANALYSIS; DRUG APPROVAL; DRUG COST; ECONOMIC EVALUATION; HEALTH CARE COST; HEALTH CARE ORGANIZATION; HUMAN; LETTER; MEDICAL DECISION MAKING; MEDICAL INFORMATION; NEW ZEALAND; PREVALENCE; PULMONARY HYPERTENSION; RESOURCE ALLOCATION; TREATMENT OUTCOME;

EID: 29844448454     PISSN: 11758716     EISSN: 11758716     Source Type: Journal    
DOI: None     Document Type: Letter

References (11)

1. Whyte K. PHARMAC not funding some treatments for rare, life-threatening diseases: bosentan as an example. N Z Med J. 2005;118(1226). URL: http://www.nzma.org.nz/journal/118-1226/1759
2. As of 5 December 2005, 28 patients were funded for PAH treatment through Exceptional Circumstances - five were using iloprost, two bosentan, 20 sildenafil, and one vardenafil. Eleven of the patients had been approved sidenafil after being declined iloprost or bosentan. A further five patients had been declined any of the PAH treatments. In addition, many patients will receive iloprost for acute treatment as inpatients. Annual expenditure on high-cost PAH treatments is currently around $600-700,000, with a roughly 20:80 split between community and hospitals. Most of the expenditure is on iloprost, either as acute in-hospital use or through EC (where the injection is nebulised).
3. Galie N, Ghofrani HA, Torbicki A, et al. Sildenafil Use in Pulmonary Arterial Hypertension (SUPER) Study Group. Sildenafil citrate therapy for pulmonary arterial hypertension. N Engl J Med. 2005;353:2148-57. http://content.nejm.org/cgi/content/full/353/20/2148
4. Wilkins MR, Paul GA, Strange JW, et al. Sildenafil versus Endothelin Receptor Antagonist for Pulmonary Hypertension (SERAPH) study. Am J Respir Crit Care Med. 2005;171:1292-7. Epub 2005 Mar 4. Abstract at http://ajrccm.atsjournals.org/cgi/content/full/171/11/1292
5. SERAPH is a head-to-head trial comparing sildenafil with bosentan that suggests that sildenafil is not demonstrably inferior to bosentan - although the primary measure was debateable and there was one death in the sildenafil group. High-dose sildenafil is not yet registered in New Zealand for PAH, but has recently been registered in the US for 'the treatment of pulmonary arterial hypertension (WHO group 1) to improve exercise ability'.
6. Highland KB, Strange C, Mazur J, Simpson KN. Treatment of pulmonary arterial hypertension: a preliminary decision analysis. Chest. 2003;124:2087-92. http://www.chestjournal.org/cgi/content/full/124/6/2087
7. TRIP search http://www.tripdatabase.com/ 9 December 2005 keywords pulmonary hypertension; PubMed searches 9 December 2005 keywords pulmonary hypertension AND (cost effectiveness OR quality adjusted life years OR cost utility or economic)
8. The Highland et al 2003 economic analysis compared bosentan with treprostinil and epoprostenol - neither used in New Zealand - in a South Carolina cost context. They did not examine sildenafil or nebulised iloprost, and relied on indirect comparisons; there were no head-to-head comparisons, and the trial data available were sparse, compounded by quite different eligibility criteria. Useful comment on this economic analysis can be found on the NHS CRD website at http://nhscrd.york.ac.uk/online/nhseed/20040088.htm
9. Grocott R, Metcalfe S. Going against the flow: the impact of PHARMAC not funding COX-2 inhibitors for chronic arthritis. N Z Med J. 2005;118(1223). URL: http://www.nzma.org.nz/journal/118-1223/1690/
10. Metcalfe S, Dougherty S, Brougham M, Moodie P. PHARMAC measures savings elsewhere to the health sector. N Z Med J. 2003;116(1170). URL: http://www.nzma.org.nz/journal/116-1170/362/
11. PHARMAC. A prescription for pharmacoeconomic analysis (version 1.1). September 2004. URL: http://www.pharmac.govt.nz/pdf/pfpa.pdf