1. PHARMAECONOMICS Pulmonary Arterial Hypertension Nelli ÄIJÖ & Feyza Nur POLAT Nika Marđetko

2. SYSTEMATIC REVIEW AND META-ANALYSIS META-ANALYSIS In meta-analysis numeral information are added together by using statistical methods. Often the data is presented as diagrams and tables. This way one big study can be made by combining information from many smaller studies. Meta-analysis must consist of studies with similar  study method  patients  measurement system

3. SYSTEMATIC REVIEW -The idea is to gather a summary of all the studies that  answer to the study question  are reliable  are valid Systematic reviews should be based on a peer-reviewed protocol so that they can be repeated:  Study design  PICOTS  Cochrane guidelines Systematic reviews are liken to an original study PRISMA statements

5. Analyzing article: “Cost Effectiveness of First-Line Oral Therapies for Pulmonary Arterial Hypertension (PAH) A Modelling Study” Input parameters for drug effectiveness: “However, recent developments in network meta-analysis techniques have provided a method by which the comparative effectiveness of treatments can be estimated in the absence of direct head-to-head trials.” “The estimated efficacy of the oral PAH therapies was derived from the recent network meta-analysis.” “We estimated the impact of initial treatments for PAH through their effects on quality-adjusted life-years (QALYs) and costs over a lifetime.”

6. Input parameters for quality of life of patients: “Although many clinical trials of PAH therapies report having measured quality of life none have reported the impact of treatment in a format that would allow estimation of QALYs.” “We therefore assigned utility values based on the severity of PAH, as measured by FC (functional class). These were obtained from a published study deriving utility values using the SF-36 with 177 Australian PAH patients.”

7. Why a meta-analysis? We think that the study conducted by Coyle co. was not purely a meta- analysis. Meta-analysis is good to be done when there are many studies about the subject Meta-analysis can help to see the bigger picture By using meta-analysis according to the instructions reliabile and valid study data can be produced.

8. Analyzing meta-analysis: CADTH Therapeutic Review Report: Drugs for pulmonary arterial hypertension: comparative efficacy, safety and cost- effectiveness. Study Design Research questions very specific (monotherapy, add-on therapy….). Then they have done search strategy and written all the search terms and defined PICOTS and exclusion criteria. They have also listed all the methods they used for the meta-analysis and network meta-analysis.

9. Results Results for each therapy group is presented separately. They have made a lot of tables and diagrams to gather the information from each therapy. They have included in the results discussion about possible errors in the studies that were included to the meta-analysis and they have also made a subgroup analysis to discuss the different populations in different studies.

10. Quality of life in pulmonary arterial hypertension; Improvement and maintenance with bosentan. Study design To the patients which has been randomly chosen, bosentan(oral dual endothelin receptor antagonist) implemented twice a day. Following days the dose has been increased. Datas were collected from each patient but the condition was to implement the bosentan at least three months. MOS SF-36 and AQOL questionnaires answered by each patient.

11. MOS SF-36 and AQOL MOS SF-36 It comes from medical outcome study. The Short Form (36) Health Survey is a 36-item, patient-reported survey of patient health. The SF-36 is a measure of health status and an abbreviated variant of it, is commonly used in health economics as a variable in the quality adjusted life year calculation to determine the cost-effectiveness of a health treatment.

12. AQOL The Assessment of Quality of Life (AQoL) instruments are health- related multi-attribute utility quality of life instruments. Initially they were designed for use in economic evaluation studies (cost utility analysis (CUA). However their use is broader and need not be limited to economic or health related work.

13. To facilitate comparisons across disease areas SF-36results were converted into utilities and the AQOL instrument was designed to measure health related quality of life. At the and other datas collected from WHO functional class status and the safety criteries checked by mortal and adverse effects and laboratory results of the patients.

14. Results The results has been categorized by patient characteristics and patient accounting. It has been clearified that there are some different effects of the diseases on different patients.

15. Among the 177study patients SF-36 scores were significiantly improved at 3 months in the domains of physical functioning,mental health and role- emotional. Improvements were seen in all ethiologic sub-groups and were maintaned in patients who remained on basenton. An improvement in AQOL measures at 3 months was also noted for patients with the baseline WHO functional class III.

16. Thank you for your attention!