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Hemodynamics in pulmonary arterial hypertension (PAH): do

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In the model epoprostenol treatment is initiated on progression to FCIV, as such the ICERs for all technologies are sensitive to the cost of epoprostenol. Due to the lack of stratified data to populate the model, and in some cases a complete absence of data, a number of assumptions had to be made, therefore bias may have been introduced by these assumptions. In addition, the data used for the model were mostly from trials of short duration containing relatively small numbers of patients. Therefore a longitudinal dataset of a sufficient number of patients would be of great benefit to future modelling in this clinical condition. Due to the above, the probabilistic sensitivity analysis undertaken in this report may well have underestimated the full uncertainty around each analysis.

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None produced results generalisable to the NHS. There was no consensus in the manufacturers' submissions on the most appropriate model structure for the technology assessment, with variability seen in the type of economic evaluation, methods used and data sources. In addition, the same comparator was not used in all submissions therefore they were not all addressing the same policy question. The strengths of this assessment report include a systematic review focusing on the most robust evidence from RCTs, comprehensive literature search, inclusion of unpublished data, comprehensive analyses highlighting the mismatch between licensed indications and available evidence, independent assessment of published economic evaluations and manufacturer submissions, a de novo model-based economic evaluation, and use of data from the systematic review to inform the model. The analyses included in this report were restricted by the scope of the technology appraisal, which was to include only licensed indications for the technologies currently licensed in the UK.

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The analyses were also limited by the short duration of RCTs and the paucity of data stratified by types of PAH and FC. Uncertainties mainly derive from the lack of long-term data from RCTs with sildenafil citrate tablets 200mg regard to how long treatment effects last and whether they differ significantly for patients in different FC and to what extent. Comparisons between the technologies were not planned, and were not considered appropriate given available evidence. Most RCTs excluded patients with unstable conditions. The patients who are seen in clinical practice may be sicker than those included in the trials. they explain long-term clinical

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2010]Hemodynamics in pulmonary arterial hypertension (PAH): do

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Second, the HTA programme provides grants for clinical trials for researchers who identify research questions. These are assessed for importance to patients and the NHS, and scientific rigour. Third, through its Technology Assessment Report (TAR) call-off contract, the HTA programme commissions bespoke reports, principally for NICE, but also for other policy-makers. TARs bring together evidence on the value of specific technologies. Some HTA research projects, including TARs, may take only months, others need several years.

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They can cost from as little as £40,000 to over £1 million, and may involve synthesising existing evidence, undertaking a trial, or other research collecting new data to answer a research problem. The final reports from HTA projects are peer reviewed by a number of sildenafil film tablet independent expert referees before publication in the widely read journal series Health Technology Assessment. Criteria for inclusion in the HTA journal series Reports are published in the HTA journal series if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. The research reported in this issue of the journal was commissioned and funded by the HTA programme on behalf of NICE as project number 05/24/01.

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The protocol was agreed in March 2007. The assessment report began editorial review in December 2007 and was accepted for publication in December 2008. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the referees for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report. they explain long-term clinical outcomes with PAH-specific

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The views expressed in this publication are those of the authors and not necessarily those of the HTA programme or the Department of Health. [Appl Health Econ Health Policy...]Oral therapies for the treatment of pulmonary arterial hypertension: a population-based cost-minimization analysis.Dranitsaris G, Mehta S. Appl Health Econ Health Policy. Review Cost effectiveness of prostacyclins in pulmonary arterial hypertension. [Appl Health Econ Health Policy...]Review Cost effectiveness of prostacyclins in pulmonary arterial hypertension.Roman A, Barberà JA, Escribano P, Sala ML, Febrer L, Oyagüez I, Sabater E, Casado MA. therapy?Steele P, Strange G, Wlodarczyk J, Dalton

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