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Phosphodiesterase 5 Inhibitor for Pediatric Pulmonary Arterial Hypertension: A Cost-Utility Analysis
Jefferson Antonio Buendía1, Erika Fernanda Lindarte1, Diana Guerrero Patiño1
1Research group in Pharmacology and Toxicology "INFARTO," Department of Pharmacology and Toxicology, University of Antioquia, Medellin, Colombia.
Insights
Tadalafil is not a cost-effective treatment for pediatric pulmonary arterial hypertension in Colombia compared to sildenafil. Further research is unlikely to change this conclusion, impacting clinical practice guidelines.
Area of Science:
- Pharmacoeconomics
- Pediatric Cardiology
- Health Technology Assessment
Background:
- Pulmonary arterial hypertension (PAH) is a severe condition in children.
- Tadalafil shows efficacy, but its cost-effectiveness for pediatric PAH in Colombia is unknown.
- Sildenafil is a common treatment, necessitating comparative economic evaluations.
Purpose of the Study:
- To determine the cost-utility of tadalafil versus sildenafil for treating pediatric PAH in Colombia.
- To compare expected costs, quality-adjusted life-years (QALYs), and outcomes.
- To inform decision-making for healthcare providers and policymakers.
Main Methods:
- A Markov model was utilized for comparative economic analysis.
- Probabilistic sensitivity analysis assessed model uncertainties.
- Value of information analysis determined the potential benefit of further research.
Main Results:
- Tadalafil is associated with an incremental cost of US $15,270 and an incremental benefit of 1.00 QALY compared to sildenafil.
- The incremental cost-effectiveness ratio (ICER) is US $15,286 per QALY.
- There is a less than 1% probability that tadalafil is more cost-effective than sildenafil at a willingness-to-pay threshold of US $5,180.
Conclusions:
- Tadalafil is not cost-effective for pediatric PAH in Colombia when compared to sildenafil.
- The findings suggest that current clinical practice guidelines may need revision.
- Decision-makers should consider these economic findings when allocating resources for pediatric PAH treatment.
Objectives:
Despite the growing evidence of efficacy, scarce information exists regarding the cost of tadalafil to improve the functional classes of pediatric patients with pulmonary arterial hypertension. This study aims to determine the cost-utility of tadalafil compared sildenafil to treat pediatric patients with pulmonary arterial hypertension in Colombia.
Methods:
A Markov model was developed to compare expected costs, outcomes, and quality-adjusted life-years of sildenafil and tadalafil in pediatric patients with pulmonary arterial hypertension. The model was analyzed probabilistically, and a value of information analysis was conducted to inform the value of conducting further research to reduce current uncertainties in the evidence base. Cost-effectiveness was evaluated at a willingness-to-pay value of US $5180.
Results:
The mean incremental cost of tadalafil versus sildenafil is US $15 270. The 95% credible interval for the incremental cost ranges from US $28 033.65 to US $5940.86. The mean incremental benefit of tadalafil versus sildenafil is 1.00 quality-adjusted life-years (QALY). The 95% credible interval for the incremental benefit ranges from 1.88 to 0.31 QALY. The expected incremental cost per QALY is estimated at US $15 286. There is a probability less than 1% that tadalafil is more cost-effective than sildenafil at a threshold of US $5180 per QALY. Form the value of information analysis, the theoretical upper bound on the value of further research was US $9.298 for Colombia.
Conclusion:
Our economic evaluation shows that tadalafil is not cost-effective regarding sildenafil to treat pediatric patients with pulmonary arterial hypertension in Colombia. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines.
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