Implications of cost-effectiveness analyses of lipid-lowering therapies: From the policy-maker's desk to the patient's bedside

Kazi, Dhruv S.; Virani, Salim S.

doi:10.1016/j.pcad.2019.10.006

Cited by 10 publications

(5 citation statements)

References 44 publications

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“…Авторы исследований по фармакоэкономическому анализу применения статинов отмечают, что существует два пути улучшения показателя «отношение стоимость/эффективность» -это либо уменьшение стоимости применяемого статина, либо повышение его эффективности. В отношении пациентов низкого и среднего ССР более выгодным признано использование более дешевых препаратов, для больных высокого и очень высокого ССР -применение, возможно, более дорогих, но максимально эффективных ЛП [16,17]. Поэтому использование розувастатина, обладающего наибольшим холестеринснижающим эффектом, считается методом выбора у пациентов с высоким и очень высоким риском сердечно-сосудистых осложнений [18].…”

Section: Discussionunclassified

Pharmacoeconomic Analysis of Therapy with Generic Statin Drugs in Patients with High and Very High Cardiovascular Risk (According to the Study PRIORITY)

Martsevich¹,

Lukina²,

Кутишенко³

2020

Racionalʹnaâ farmakoterapiâ v kardiologii

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Aim. To perform a pharmacoeconomical assessment of the use of generic statin drugs in patients with high and very high cardiovascular risk (CVR) in real clinical practice based on the data of the study PRIORITY.Material and methods. The PRIORITY study included 298 patients with high (29; 9.7%) and very high (269, 90.3%) CVR. All patients were recommended to take the reproduced drugs of atorvastatin and rosuvastatin in an individually prescribed dose. After 1 month (B1), if the target level of lowdensity lipoprotein cholesterol (LDL-C) was not reached, the statin dose was titrated. After 3 months of follow-up (B3), the hypolipidemic effect of statin therapy was evaluated. 295 people completed the study, 285 patients had the results of the lipid profile. To perform a pharmacoeconomic analysis and evaluate the “cost/effectiveness” ratio, we used the prices of generic statins in one of the online pharmacies. The effectiveness of statins was determined by the LDL-C reduction, as well as by the percentage of achieving the target LDL-C level.Results. At the first stage of the pharmacoeconomic analysis, the criterion for the effectiveness of 3-month lipid-lowering therapy was a decrease in LDL-C level by 1 mmol/l. The median and interquartile range of the ratio “cost/effectiveness” indicator for atorvastatin was 658.2 (431.5; 1257.1) RUB/mmol/l, and for rosuvastatin – 621.0 (390.7; 940.6) RUB/mmol/l (p=0.45). The results of a comparative assessment of the “cost/effectiveness” ratio (with the abovementioned effectiveness indicator) in subgroups of patients with high and very high CVR, with the achievement and nonachievement of the target level of LDL-C, adherent and non-adherent to statins, revealed the economic advantage of statins in groups of adherent patients (p=0.35), high-risk patients (p<0.0001) and individuals who reached the target level of LDL-C (p=0.002) when compared with the corresponding comparison groups. Despite the revealed high effectiveness of rosuvastatin at doses of 20-40 mg/day (assessed by the cost/effectiveness of achieving the target values of LDL-C for specific doses of statins), calculation of the “cost/effectiveness” ratio for each reproduced statin, in general, showed a higher economic effectiveness of atorvastatin.Conclusion. Pharmacoeconomic analysis of therapy with generic statin drugs, performed according to the data of the non-randomized uncontrolled study, allows to justify the economic efficiency and advantages of these drugs in various subgroups of patients who need statin therapy.

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Section: Discussionunclassified

Pharmacoeconomic Analysis of Therapy with Generic Statin Drugs in Patients with High and Very High Cardiovascular Risk (According to the Study PRIORITY)

Martsevich¹,

Lukina²,

Кутишенко³

2020

Racionalʹnaâ farmakoterapiâ v kardiologii

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“…Novel, high-cost medications, such as self-injectable monoclonal antibodies against PCSK9 enzyme, may be clinically beneficial [ 276 , 278 ] but may not meet traditional cost-effectiveness thresholds in many countries without substantial price discounts [ 279 ]. On the other hand, analyses have shown that the adoption of generic statin formulations in eligible individuals is likely cost-saving, that is, the therapies more than pay for themselves in the long run due to savings that result from averted events [ 280 , 281 ]. The economic value of other medical interventions, such as blood pressure medications, varies with the uptake and cost of generic formulations, but blood pressure control in populations at risk of recurrent events, particularly stroke, is typically cost-effective.…”

Section: Cost-effectiveness Of Scaling Up Secondary Preventionmentioning

confidence: 99%

World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease: 2023 Update

Laranjo,

Lanas,

Sun

et al. 2024

Global Heart

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Background: Secondary prevention lifestyle and pharmacological treatment of atherosclerotic cardiovascular disease (ASCVD) reduce a high proportion of recurrent events and mortality. However, significant gaps exist between guideline recommendations and usual clinical practice. Objectives: Describe the state of the art, the roadblocks, and successful strategies to overcome them in ASCVD secondary prevention management. Methods: A writing group reviewed guidelines and research papers and received inputs from an international committee composed of cardiovascular prevention and health systems experts about the article’s structure, content, and draft. Finally, an external expert group reviewed the paper. Results: Smoking cessation, physical activity, diet and weight management, antiplatelets, statins, beta-blockers, renin-angiotensin-aldosterone system inhibitors, and cardiac rehabilitation reduce events and mortality. Potential roadblocks may occur at the individual, healthcare provider, and health system levels and include lack of access to healthcare and medicines, clinical inertia, lack of primary care infrastructure or built environments that support preventive cardiovascular health behaviours. Possible solutions include improving health literacy, self-management strategies, national policies to improve lifestyle and access to secondary prevention medication (including fix-dose combination therapy), implementing rehabilitation programs, and incorporating digital health interventions. Digital tools are being examined in a range of settings from enhancing self-management, risk factor control, and cardiac rehab. Conclusions: Effective strategies for secondary prevention management exist, but there are barriers to their implementation. WHF roadmaps can facilitate the development of a strategic plan to identify and implement local and national level approaches for improving secondary prevention.

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“…Factors that limit that use of PCSK9 inhibitors include cost, insurance authorization, and the requirement for frequent injections [ 53 , 54 ]. Currently, an oral PCSK9 inhibitor, MK-0616, is undergoing evaluation.…”

Section: Monoclonal Antibodiesmentioning

confidence: 99%

Monoclonal Antibodies, Gene Silencing and Gene Editing (CRISPR) Therapies for the Treatment of Hyperlipidemia—The Future Is Here

et al. 2023

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Hyperlipidemia is a significant risk factor for atherosclerotic cardiovascular disease. Undertreatment of elevated lipids persists despite existing therapies. Here, we provide an update on monoclonal antibodies, gene silencing therapies, and gene editing techniques for the management of hyperlipidemia. The current era of cutting-edge pharmaceuticals targeting low density lipoprotein cholesterol, PCSK9, lipoprotein (a), angiopoietin-like 3, and apolipoprotein C3 are reviewed. We outline what is known, studies in progress, and futuristic goals. This review of available and upcoming biotechnological lipid therapies is presented for clinicians managing patients with familial hyperlipidemia, statin intolerance, hypertriglyceridemia, or elevated lipoprotein (a) levels.

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Implications of cost-effectiveness analyses of lipid-lowering therapies: From the policy-maker's desk to the patient's bedside

Cited by 10 publications

References 44 publications

Pharmacoeconomic Analysis of Therapy with Generic Statin Drugs in Patients with High and Very High Cardiovascular Risk (According to the Study PRIORITY)

Pharmacoeconomic Analysis of Therapy with Generic Statin Drugs in Patients with High and Very High Cardiovascular Risk (According to the Study PRIORITY)

World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease: 2023 Update

Monoclonal Antibodies, Gene Silencing and Gene Editing (CRISPR) Therapies for the Treatment of Hyperlipidemia—The Future Is Here

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