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Pulmonary Arterial Hypertension (PAH) medicines utilisation analysis

Page last updated: 3 July 2015

Drug utilisation sub-committee (DUSC)

February 2015

Abstract

Purpose

To assess the utilisation of medicines listed on the Pharmaceutical Benefits Scheme (PBS) for the treatment of pulmonary arterial hypertension (PAH).

 Following the listing of sitaxentan in April 2008, the DUSC requested that the Secretariat maintain a watching brief on the utilisation of the group of medicines used in the treatment of PAH. Consequently an analysis of PAH medicines was presented to DUSC at its June 2010 meeting. The current report updates and enhances this report.

Date of listing on PBS

  • bosentan: 1 March 2004
  • iloprost: 1 April 2005
  • epoprostenol: 1 August 2006
  • sildenafil: 1 March 2007
  • sitaxentan: 1 April 2008, delisted 31 March 2011
  • ambrisentan: 1 December 2009
  • tadalafil: 1 April 2012
  • macitentan: 1 September 2014

Data Source / methodology

  • PBS pharmacy claims data from the DUSC database and the Department of Human Services (DHS) prescription databases.
  • Authority Approval data from the DHS Authority Approval database

Key Findings

  • The number of patients starting on a PAH medicine for the first time is steady at approximately 420 patients each year. Until mid-2014, bosentan was the most frequently prescribed first PAH medicine. Macitentan has become the most common medicine for new patients since it was listed on 1 September 2014.
  • The number of prevalent patients continues to increase over time, presumably due to improved survival.  There were 2026 prevalent patients in 2013.
  • The age of patients initiating treatment has increased over the last decade. The mean age of new patients was 53.2 years in 2003/04 and 64.1 years in 2013/14.  This compares with a mean age of 48.8 years in patients in the bosentan arms of the key clinical trials.
  • The mean time on treatment was 4.63 years (all excluding breaks) and 4.72 years (all including breaks).
  • The average prescribed dose of epoprostenol is higher than expected. This may reflect treatment of a more severe population as epoprostenol is restricted to class IV patients. However the cost-effectiveness of higher doses is not known.

Full Report