For a study, researchers sought to compare the cost-utility of catheterization-required therapy in preterm babies with pulmonary hypertension to the empiric beginning of sildenafil based only on echocardiographic data.
A Markov state transition model was built to simulate the clinical scenario of a preterm infant with echocardiographic evidence of pulmonary hypertension associated with bronchopulmonary dysplasia (BPD) but no congenital heart disease who is considering starting pulmonary vasodilator therapy via one of two modeled treatment strategies—empiric or catheterization-obligate. From the literature, transitional probabilities, costs, and utilities were extracted. The indicator for plan efficacy was predicted quality-adjusted life-years. Each variable was subjected to sensitivity testing. The findings were tested for durability using a 1,000-patient Monte Carlo microsimulation.
When compared to the empiric treatment technique, the catheterization-obligate strategy cost $10,778 more and resulted in 0.02 fewer quality-adjusted life-years. Across all scenarios considered using one-way sensitivity analysis and Monte Carlo microsimulation, empiric therapy remained the more cost-effective paradigm (cost-effective in 98% of cases).
When compared to catheterization-obligate therapy, empiric sildenafil medication in babies with pulmonary hypertension associated with BPD is a superior method with lower costs and greater efficacy. The data implied that in preterm children with simple pulmonary hypertension associated with BPD, skipping catheterization before starting sildenafil is an acceptable option.