The cost-effectiveness of prostanoids in pulmonary arterial hypertension (PAH) has recently been called into question by the National Institute for Health and Clinical Excellence (NICE),1 and the possibility exists that this treatment would not be recommended by this body. This would be the first time that a treatment already in routine clinical practice would be withdrawn as a result of NICE recommendations. Guidelines published by the UK, European and US authorities still advocate prostanoid use in certain patient groups.2^–4 Of the disease-targeted therapy available for PAH, only epoprostenol has been shown to improve patient survival in the context of a randomised controlled trial.5

To assess the impact that withdrawal of intravenous epoprostenol in 1997 would …