Original Title: Treprostinil en hipertensión arterial pulmonar secundario a tromboembolismo pulmonar (grupo 4)

Authors' recommendations: Moderate-quality evidence shows that the use of treprostinil in persistent or inoperable Functional Class III-IV Chronic Thromboembolic Pulmonary Hypertension (CTEPH, Group 4) probably provides a lower net benefit because it improves the disease functional class, six-minute walking distance and reduces the pulmonary vascular resistance when compared with placebo. In addition, it shows related benefits, since treprostinil is the only prostacyclin indicated for severe CTEPH that may be subcutaneously and not intravenously administered Very low-quality evidence suggests that, when compared with placebo, treprostinil used in inoperable or persistent Functional Class III-IV CTEPH may result in a lower net benefit in addition to the benefits associated to its subcutaneous administration. Among the clinical practice guidelines consulted, the one issued by the European Cardiology Society in association with the European Respiratory Society in 2022, is the only one recommending subcutaneous treprostinil in patients with inoperable persistent/recurrent Functional Class III-IV CTEPH after pulmonary endarterectomy. The rest of the guidelines consulted mention the use of riociguat in inoperable or persistent CTEPH. No coverage policies on the use of treprostinil in CTEPH have been found in the Latin-American countries consulted. As regards the high-income countries consulted, this technology is considered for other pulmonary arterial hypertension etiology groups, other than CTEPH. In Argentina, this technology has not been included in the Mandatory Medical Program. In the case of the Unique Reimbursement System of the Superintendence of Health Services, treprostinil is reimbursed in patients with Group 1 pulmonary arterial hypertension only. Although there is no evidence on the cost-effectiveness of treprostinil in Argentina, there are enough elements to conclude that it would not be cost-effective since it is expensive when compared with its comparator and was explicitly excluded from coverage in other health systems.

Project Status: Completed

URL for project: https://www.iecs.org.ar/publicacion/?id=23201

Year Published: 2022

URL for published report: https://www.iecs.org.ar/publicacion/?id=23201

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: <p>Institute for Clinical Effectiveness and Health Policy (IECS)</p>