BACKGROUND AND OBJECTIVE: Clinicians must choose between an increasing number of 
medications for the treatment of pulmonary arterial hypertension (PAH) with 
different routes of administration, adverse effects, costs and efficacies. We 
constructed a decision analysis to help inform treatment choices in PAH.
METHODS: We created a Markov-type model to evaluate 1-year treatment with 
bosentan, treprostinil, epoprostenol, inhaled iloprost, sildenafil, sitaxentan 
and ambrisentan. Transition probabilities were based on observed transitions 
between WHO functional classes, adjusted by relative risk of improvement in a 
6-minute walk test. Utilities were based on reported values for each functional 
class, adjusted for burden of treatment administration. Costs were estimated 
from Medicare and Medicaid reimbursement data. Sensitivity analyses evaluated 
changes in efficacy, utilities and costs.
RESULTS: Treatment with sildenafil was less costly and resulted in a greater 
gain in quality-adjusted life-years (QALYs) compared with other treatments. 
Treatment with ambrisentan and bosentan resulted in the same gain in QALYs as 
sildenafil, but at a higher cost. Sensitivity analyses had minimal impact on 
these results.
CONCLUSIONS: Based on this model, sildenafil is a cost-effective treatment for 
PAH with a low price and a net increase in QALYs. The results from this analysis 
are a tool to help guide clinicians in deciding which PAH medications to use; 
however, the final decisions should be individualized because the effectiveness 
of therapy, resulting utilities and acceptable costs will differ with each 
patient.