Updated Cost-effectiveness Assessments of PCSK9 Inhibitors From the Perspectives of the Health System and Private Payers

Abstract

At current prices, the addition of PCSK9i to statin therapy is estimated to provide an additional quality-adjusted life year for $337 729 . Significant discounts are necessary to meet conventional cost-effectiveness standards.

Are PCSK9 Inhibitors Cost Effective?

“…Arrieta and co-workers performed two cost-effectiveness analyses (21,22). In the baseline scenario of the first analysis the effect of PCSK9 inhibitors was modelled directly according to 2015 outcome data on cardiovascular events, while in an alternate scenario the effect of PCSK9 on outcomes was modelled indirectly through to LDL reductions (21).…”

“…In the baseline scenario of the first analysis the effect of PCSK9 inhibitors was modelled directly according to 2015 outcome data on cardiovascular events, while in an alternate scenario the effect of PCSK9 on outcomes was modelled indirectly through to LDL reductions (21). The second analysis, an update of the original cost-effectiveness assessment, integrates evidence from the FOURIER trial (22). Each analysis used the Framingham risk equations to model risk of CVD, and each included a number of scenario analyses.…”

Evaluation of the cost-effectiveness of evolocumab in the FOURIER study: a Canadian analysis

“…Arrieta and colleagues 20 published an updated model estimating a cost of US$337 729 per QALY and requiring a discount to $5459 per year to reach US$100 000 per QALY. Similarly, Kazi and colleagues 19 updated earlier estimates to US$339 000 per QALY, requiring a discount to US$4215 to achieve US$100 000 per QALY when comparing to the addition of ezetimibe.…”

Clinical guidance on the contemporary use of proprotein convertase subtilisin/kexin type 9 monoclonal antibodies

“…Results from the FOURIER trial suggest that a statin plus PCSK9 monoclonal antibody had a low probability (<1%) of being cost‐effective at the generally accepted $100 000 per quality‐adjusted life‐year societal threshold. In addition, PCSK9 monoclonal antibodies produced a negative return on investment for 86% of private payers, with threshold analysis suggesting that the price of the drug would need to drop by 62% to meet conventional cost‐effectiveness standards . However, in patients with heterozygous FH or ASCVD, budget impact analysis of PCSK9 monoclonal antibodies suggest that the financial impact of these inhibitors as add‐ons to statin therapy is relatively low compared to published estimates of other specialty biologics, with drug cost rebates and discounts likely to further reduce the impact …”