Updated Cost-effectiveness Analysis of Evolocumab in Patients With Very High-risk Atherosclerotic Cardiovascular Disease

Abstract

cholesterol management guideline was released. An updated cost-effectiveness analysis of evolocumab in the United States may be therefore of interest to payers and prescribers. OBJECTIVE To present an updated cost-effectiveness analysis of evolocumab added to standard background therapy compared with standard background therapy alone in patients with very high-risk atherosclerotic cardiovascular disease, reflecting the 2018 ACC/AHA guideline definition and using the new evolocumab list price. DESIGN, SETTING, AND PARTICIPANTS This study used the Markov model originally used in a previous study by Fonarow et al in 2017. A US societal perspective was considered, and a range of baseline cardiovascular event rates were modeled to reflect varying risk profiles in clinical practice within patients with very high-risk atherosclerotic cardiovascular disease. EXPOSURES Addition of evolocumab to standard background therapy, including maximally tolerated statin therapy (ie, the maximum intensity of statin therapy a patient can safely receive), with or without ezetimibe. MAIN OUTCOMES AND MEASURES Major cardiovascular events (myocardial infarction, ischemic stroke, and cardiovascular death), costs, quality-adjusted life-years, and incremental cost-effectiveness ratios. RESULTS Evolocumab was associated with both increased costs and improved outcomes when added to standard background therapy. Incremental costs ranged from $22 228 to $3411, depending on the varying level of risk within the defined population. Incremental quality-adjusted life years ranged from 0.39 to 0.44. Incremental cost-effectiveness ratios ranged from $56 655 to $7667 per quality-adjusted life-year gained. For a range of baseline cardiovascular event rates in patients with very high-risk atherosclerotic cardiovascular disease, incremental cost-effectiveness ratios were below the generally accepted willingness-to-pay thresholds. Moreover, the ratios were below the threshold of $50 000 per quality-adjusted life-years gained for any baseline rate of 6.9 or more events per 100 patient-years. CONCLUSIONS AND RELEVANCE At its current list price, the addition of evolocumab to standard background therapy meets accepted cost-effectiveness thresholds across a range of baseline cardiovascular event rates in patients with very high-risk atherosclerotic cardiovascular disease as defined by the 2018 ACC/AHA guideline.

Update on cardiovascular prevention in clinical practice: A position paper of the European Association of Preventive Cardiology of the European Society of Cardiology

“…Cost-effectiveness can be a critical issue in the context of the prescription of PCSK9 inhibitors 141 and a selective adoption to very high-risk CVD patients to reduce the overall budgetary impact of PCSK9 inhibitor treatment has been advised. 142,143 Omega-3 fatty acids. Patients with elevated triglyceride levels are at increased risk of ischaemic events; the REDUCE-IT trial evaluated the effect of icosapent ethyl (a highly purified eicosapentaenoic acid ethyl ester, 4 g daily) in 8179 patients with established CVD under statin therapy and with high fasting triglyceride levels (135-499 mg/dL).…”

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

“…Overall, 16 out of the 32 included studies declared specific funding for the project, and from those, 10 studies declared industry support. Three out of 10 studies [13,35,36] were funded by industry for ezetimibe (30%), five out of 15 [26,29,[37][38][39] for PCSK9 inhibitors (33%), one out of five (20%) [40] for n-3 PUFAs, and one out of seven (14%) [41] for the polypill. Granular information on funding sources can be accessed in Appendix 5 (see ESM).…”

“…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.…”

ESVM Guideline on peripheral arterial disease

“…61 % of PAD patients recruited had had an intervention, 40 % had diabetes, and the evidence showed the lower the LDL the better in terms of CV outcome with no lower limit being recommended and no overt side effects from this lower LDL. However, at present cost precludes us treating all patients, although a cost benefit analyses shows acceptable cost-effective thresholds [144] and so we recommend the following therapeutic strategy:…”