Introduction: Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) can reduce low density lipoprotein (LDL) levels by approximately 60% when added to maximally tolerated statins, which leads to a decrease in atherosclerotic events. For patients with intracranial atherosclerosis >70%, who are at high risk of recurrent stroke, these agents may significantly lessen recurrent stroke events. Methods: With individual patient data from the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study, we utilized prior estimates of the LDL-lowering effect on reduction of recurrent stroke rates to estimate cost-effectiveness of PCSK9i. Using a base-case assumption of 32% relative risk reduction for recurrent stroke in this population, and cost parameters drawn from current US healthcare expenditures (with a willingness-to-pay WTP threshold of 50% cost-effective at a margin of 5, 000/year and a WTP threshold of <100, 000. With higher costs of recurrent stroke (150% of base), there is a 59. 1% probability of cost-effectiveness for agents priced at 5, 000/year; with higher treatment effectiveness (50%), the probability of cost-effectiveness increases to 74. 3%. Conclusion: This theoretical framework does not demonstrate cost-effectiveness of currently available PCSK9i for the prevention of recurrent ischemic stroke in patients with severe intracranial atherosclerosis. The added benefits of PCSK9i in reducing coronary events and disability associated with lower rates of stroke or myocardial infarction may render these agents cost-effective for all atherosclerotic outcomes; however, this warrants further study.
Kellogg et al. (Thu,) studied this question.