Prevalence of pulmonary arterial hypertension in the Camerino area of central Italy and savings resulting from generic bosentan

Eur J Hosp Pharm. 2020 Mar;27(2):100-102. doi: 10.1136/ejhpharm-2018-001660. Epub 2018 Oct 24.


Objective: Pulmonary arterial hypertension is a rare and progressive respiratory disease characterised by high blood pressure and vascular resistance producing right ventricular fatigue. In Italy, pulmonary hypertension can be treated with different drugs available on the market at different costs, and in the Marche region distributed exclusively by hospital pharmacies. The present study examined in an area of the Marche region the use of drugs specifically indicated for pulmonary hypertension, and evaluated how the introduction of the generic bosentan might lower pharmaceutical costs for the healthcare budget.

Methods: The study examined oral administration prescriptions and costs using data from the Apotheke Gold (Record Data) database from 1 January 2012 to 31 August 2017.

Results: Annually (from 1 January 2012 to 31 August 2017), an average of 4.83 patients were treated (prevalence of 102.35 cases per 1 million residents) with ambrisentan (Volibris), bosentan (Tracleer), macitentan (Opsumit), tadalafil (Adcirca) or sildenafil (Revatio). The total expenditure during the 5-year 8-month period was €472 405. Ambrisentan was by far the most expensive product overall, with a total expenditure of €222 380 for the period studied (a daily cost of €67.39), even though Tracleer had the highest cost for a day of treatment (a daily cost of €94.48, but a total expenditure of €163 976 for the period, due to its more recent marketing). Providing patients with the generic form bosentan in place of Tracleer would lower the costs dramatically. A very significant annual savings per patient of approximately €31 879 would be achieved, a striking 92.4% reduction in costs.

Conclusion: The prevalence of pulmonary arterial hypertension reported for Camerino and its surrounding area in the Marches region is quite high compared with that reported by other authors for France and Scotland. The introduction of the generic bosentan would cut costs drastically. It is to be hoped that centralised procurement at the regional level would bring further savings.

Keywords: drug procurement; ethics (see medical ethics); health economics; pharmacoeconomics; pharmacy management (organisation, financial).

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / economics*
  • Antihypertensive Agents / therapeutic use
  • Bosentan / economics*
  • Bosentan / therapeutic use
  • Cost Savings / economics*
  • Cost Savings / trends
  • Drug Costs* / trends
  • Drugs, Generic / economics*
  • Drugs, Generic / therapeutic use
  • Female
  • Humans
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Pharmacy Service, Hospital / economics
  • Pharmacy Service, Hospital / trends
  • Prevalence
  • Pulmonary Arterial Hypertension / drug therapy
  • Pulmonary Arterial Hypertension / economics*
  • Pulmonary Arterial Hypertension / epidemiology


  • Antihypertensive Agents
  • Drugs, Generic
  • Bosentan