Cost-Effectiveness of PCSK9 Inhibitor Plus Statin in Patients With Triple-Vessel Coronary Artery Disease in Japan

Kodera, Satoshi; Morita, Hiroyuki; Kiyosue, Arihiro; Ando, Jiro; Takura, Tomoyuki; Komuro, Issei

doi:10.1253/circj.cj-17-1455

Cited by 15 publications

(33 citation statements)

References 42 publications

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“…Of note, the study by Dressel et al [28] used ezetimibe as a comparator, but did not report the ICER for ezetimibe. Only five out of 32 studies [31,32,34,45,53] were set in LMICs, and only seven [31,32,34,45,46,49,53] were based in non-Western countries. Most of the studies analysed lifetime horizons (28 studies) [12, 13, 25-29, 31-40, 42-52, 55], and the majority used Markov models (29 studies) [12, 13, 26, 28-33, 35-52, 54, 55].…”

Section: General Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Among the 15 selected studies evaluating PCSK9 inhibitors, three were updates from previous published models incorporating new clinical or pricing data [38,44,48], and the rest were original research articles. Eight studies were set in the US [12,26,29,37,38,43,44,48], two in Spain [30,39], and the rest in Japan [46], Norway [33], Australia [47], Germany [28] and Thailand [45]. The comparator was statins or statins plus ezetimibe.…”

Section: Proprotein Convertase Subtilisin/kexin Type 9 (Pcsk9) Inhibimentioning

confidence: 99%

“…All the studies used a Markov model with yearly cycles except Kumar et al [47], who modelled 5-year cycles, and all used lifetime horizons with the exception of Olry de Labry Lima et al [30], who used a 10-year time horizon [30]. The model structure varied, with studies simulating from three [45] to eleven [39] health states, and important differences in the variety of the included cardiovascular events, with fatal and non-fatal myocardial infarction and fatal and non-fatal stroke modelled in 13 studies [12,26,28,33,[37][38][39][43][44][45][46][47][48]. Three of the studies [12,43,44] used the CVD Policy Model.…”

Section: Proprotein Convertase Subtilisin/kexin Type 9 (Pcsk9) Inhibimentioning

confidence: 99%

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743 WITHDRAWN:Â Novel Treatment Strategies for Secondary Prevention of Cardiovascular Disease: A Systematic Review of Cost-Effectiveness

2020

Heart, Lung and Circulation

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Background New pharmacological therapies for the treatment of cardiovascular disease (CVD) have emerged in recent years. The high rates of CVD and the need for long-term treatment to decrease risk factors makes cost-effectiveness crucial for their successful long-term implementation. Objective This study assessed cost-effectiveness studies of novel pharmacological treatments (ezetimibe, proprotein convertase subtilisin/kexin type 9 [PCSK9] inhibitors, omega-3 polyunsaturated fatty acids [n-3 PUFAs], and the cardiovascular polypill) compared with standard care for the secondary prevention of CVD. Methods We searched seven databases and the reference list of selected literature reviews for eligible cost-effective analyses (CEA) published between January 2009 and January 2020 that evaluated the above novel treatments versus standard care. Two independent reviewers performed the screening and evaluation in accordance with the Consolidated Health Economic Evaluation Reporting Standards statement. Cost results were adapted to 2018 US dollars (US$) to facilitate comparisons between studies. Consideration of cost-effectiveness was based on the original study criteria. Results Thirty-two studies were included in this review, most of them adopting a healthcare perspective. Studies evaluating ezetimibe, PCSK9 inhibitors and n-3 PUFAs assessed their addition to standard care compared with standard care alone, while studies analysing the polypill evaluated the replacement of multiple monotherapies for a fixed-dose combination. Ten studies reported on ezetimibe, fifteen evaluated PCSK9 inhibitors, five focused on n-3 PUFAs and seven on the polypill. From a healthcare perspective, ezetimibe was cost effective in 62.5% of the studies (incremental cost-effectiveness ratios [ICERs]

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Section: General Characteristics Of the Included Studiesmentioning

confidence: 99%

Section: Proprotein Convertase Subtilisin/kexin Type 9 (Pcsk9) Inhibimentioning

confidence: 99%

Section: Proprotein Convertase Subtilisin/kexin Type 9 (Pcsk9) Inhibimentioning

confidence: 99%

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743 WITHDRAWN:Â Novel Treatment Strategies for Secondary Prevention of Cardiovascular Disease: A Systematic Review of Cost-Effectiveness

2020

Heart, Lung and Circulation

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“…We carefully set reasonable models in the present study based on previous studies. 8,9,13,20, 21 We selected the same parameters as those used in a meta-analysis and in large randomized control trials. We added scenario analyses and sensitivity analyses to reinforce the weak points of model research.…”

Section: Study Limitationsmentioning

confidence: 99%

Cost-Effectiveness of Percutaneous Coronary Intervention Compared With Medical Therapy for Ischemic Heart Disease in Japan

Kodera

Morita

Kiyosue

et al. 2019

Circ J

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Evaluation 2 (FAME 2) trial, a large randomized controlled trial evaluating patients with AP, cardiovascular events were significantly reduced in the fractional flow reserve (FFR)-guided PCI group. 3,4 The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, however, a large randomized controlled trial evaluating patients with AP, showed no difference in cardiovascular events between PCI and medical therapy. 5 The initial PCI method for STEMI differs to that for AP. That is, primary PCI is performed for STEMI patients while FFR-guided PCI is performed for AP patients. Consequently, the cost-effectiveness of PCI should be evaluated separately for STEMI and AP. Variable results have been reported for the cost-effectiveness of PCI over medical treatment for STEMI and AP. 6-14 Many studies showed that PCI in STEMI was cost-effective compared with medical therapy, 6-9 and some studies reported that PCI for AP was cost-effective compared with medical therapy, whereas others reported PCI for AP was not cost-effective. Background:The cost-effectiveness of percutaneous coronary intervention (PCI) for ischemic heart disease is undetermined in Japan. The aim of this study was to analyze the cost-effectiveness of PCI compared with medical therapy for ST-elevation myocardial infarction (STEMI) and angina pectoris (AP) in Japan. Methods and Results:We used Markov models for STEMI and AP to assess the costs and benefits associated with PCI or medical therapy from a health system perspective. We estimated the incremental cost-effectiveness ratio (ICER), expressed as qualityadjusted life-years (QALY), and ICER <¥5 m per QALY gained was judged to be cost-effective. The impact of PCI on cardiovascular events was based on previous publications. In STEMI patients, the ICER of PCI over medical treatment was ¥0.97 m per QALY gained. The cost-effectiveness probability of PCI was 99.9%. In AP patients, the ICER of fractional flow reserve (FFR)-guided PCI over medical treatment was ¥4.63 m per QALY gained. The cost-effectiveness probability of PCI was 50.4%. The ICER of FFR-guided PCI for asymptomatic patients was ¥23 m per QALY gained. Conclusions:In STEMI patients, PCI was cost-effective compared with medical therapy. In AP patients, FFR-guided PCI for symptomatic patients could be cost-effective compared with medical therapy. FFR-guided PCI for asymptomatic patients with myocardial ischemia was not cost-effective.

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“…Recently, the Randomized Evaluation of Aggressive or Moderate Lipid Lowering Therapy with Pitavastatin in Coronary Artery Disease (REAL-CAD) study clearly showed that 4-mg compared with 1-mg doses of pitavastatin significantly reduced CV events in Japanese patients with issue of the Journal, Kodera et al conclude that combined use of a PCSK9 inhibitor plus a statin is not cost-effective in Japanese patients with triple-vessel coronary artery disease but shows good cost-effectiveness in those with poorly controlled familial hypercholesterolemia. 7 The Japanese Ministry of Health, Labour and Welfare reported in 2017 that national medical expenditure in fiscal year 2015 exceeded 42,364 billion yen, a 3.8%, or 1,557 billion yen increase over the previous year. 8 Therefore, a trade-off between health care and cost is necessary.…”

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confidence: 99%

Trade-Off Between Lipid-Lowering Therapy and Costs in Patients With Cardiovascular Disease

Ishii

Murohara

2018

Circ J

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Figure. Cumulative incidence of a key endpoint for the FOURIER trial and the READ-CAD study: a composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization in the FOURIER trial and a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, unstable angina requiring emergency hospitalization, or coronary revascularization based on clinical indication in the READ-CAD study. In the FOURIER trial, low-density lipoprotein cholesterol (LDL-C) levels were approximately 30 mg/dL and 90 mg/dL in the evolocumab and placebo groups, respectively, at 3-year follow-up. 6 In the the READ-CAD study, LDL-C levels were approximately 91 mg/dL and 77 mg/dL in the pitavastatin 1-mg and 4-mg groups, respectively-at 3-year follow-up. 3

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Cost-Effectiveness of PCSK9 Inhibitor Plus Statin in Patients With Triple-Vessel Coronary Artery Disease in Japan

Cited by 15 publications

References 42 publications

743 WITHDRAWN:Â Novel Treatment Strategies for Secondary Prevention of Cardiovascular Disease: A Systematic Review of Cost-Effectiveness

743 WITHDRAWN:Â Novel Treatment Strategies for Secondary Prevention of Cardiovascular Disease: A Systematic Review of Cost-Effectiveness

Cost-Effectiveness of Percutaneous Coronary Intervention Compared With Medical Therapy for Ischemic Heart Disease in Japan

Trade-Off Between Lipid-Lowering Therapy and Costs in Patients With Cardiovascular Disease

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