Budget-Impact of Selexipag For The Treatment of Pulmonary Arterial Hypertension (PAH) In Greece

OBJECTIVES: To estimate the budgetary impact for the National Organization for Healthcare Provision (EOPYY) in Greece of adopting selexipag in insufficiently-controlled functional class (FC) III patients with pulmonary arterial hypertension (PAH) in triple therapy with endothelin receptor agonist (ERA) and a phosphodiesterase type 5 inhibitor (PDE-5i). Prostacyclin analogs (PGI2) currently indicated for triple therapy (treprostinil, iloprost, epoprostenol) have burdensome and/or invasive administration modes compared to oral selexipag. METHODS: A budget-impact model with five-year time horizon was used (2017-2021). The target population consisted of both prevalent and incident FC III patients insufficiently treated with ERA and PDE-5i and eligible to receive triple therapy Annual total costs of treatment were calculated and compared for two scenarios: market distributions with and without selexipag included. Epidemiology inputs, mortality rates, incidence of adverse events and market share estimates were based on expert consultation and published literature. Selexipag is assumed to be used in PGI2- naive patients taking share from other drugs acting on the PGI2 pathway. Official published sources were used to derive drug acquisition (hospital prices), administration, monitoring and adverse event costs (€, 2017). RESULTS: The number of FC III PAH patients treated with selexipag as add-on to ERA and PDE-5i was projected to be 21 in 2017 and 77 in 2021. The 5-year total cost is expected to be reduced by 19.13% (€11,610,710), corresponding to cost-savings of €126,880 per patient (€536,232 versus €663,112), after the introduction of selexipag added to double background therapy. Cost savings were mostly driven by reduced drug, administration and consumables cost. Sensitivity analyses showed that the results were mostly influenced by PAH prevalence, incident usage of other PGI2 and proportion of FC III patients. CONCLUSIONS: The adoption of selexipag as a treatment option for PAH FC III triple therapy may result in budget savings for the public payer, in the Greek healthcare setting.