Olpasiran and pelacarsen were highly cost-effective for secondary prevention of coronary heart disease, saving 3.29 and 8.63 undiscounted QALYs respectively compared to standard of care.
Does olpasiran or pelacarsen added to standard of care improve quality-adjusted life years cost-effectively in patients with CHD and elevated Lp(a)?
Markov modeling suggests that adding olpasiran or pelacarsen to standard of care is highly cost-effective for secondary prevention of CHD in patients with elevated Lp(a) in Bulgaria.
Purpose: In recent studies elevated lipoprotein(a) (Lp(a)) levels have been identified as an independent and causal risk factor for atherosclerosis and coronary heart disease. This study aims to perform a comparative early health technology assessment (HTA) of olpasiran and pelacarsen for secondary prevention of coronary heart disease (CHD) in patients with atherosclerotic cardiovascular disease, familial hypercholesterolemia, and elevated Lp(a). Patients and Methods: We developed a Markov state transition model to simulate the progression of a cohort of 597 patients with history of coronary heart disease (CHD) as myocardial infarction, coronary artery disease or peripheral artery disease, familial hypercholesterolaemia in the treatment arms of OCEAN(a)-Outcomes trial (NCT05581303) 16 and Lp(a) HORIZON trial (NCT04023552). Baseline risks of CHD, costs and utilities were obtained from published sources. Clinical trial data were used to derive reductions in lipoprotein(a). Mendelian randomization study data were used to estimate clinical benefits. Annual discounting was 3.5%. Results: The treating strategy comprising olpasiran 150 mg every 3 months in addition to standard of care saved 3.29 QALYs, compared with standard of-care alone. With 3.5% annual discounting, there were 0.23 QALYs saved. The treating strategy comprising pelacarsen 80 mg every month in addition to standard of care saved 8.63 QALYs, compared with standard of-care alone (undiscounted). With 3.5% annual discounting, there were 0.58 QALYs saved. Conclusion: We found that olpasiran was highly cost-effective at the annual price of 10,424.78 BGN, compared with standard-of-care alone. Pelacarsen was highly cost-effective at the annual price of 6105.99 BGN. The threshold applied is that of gross domestic product (GDP) per capita as indicated by the National Council on prices and reimbursement of medicinal products in Bulgaria. Keywords: lipoprotein(a), olpasiran, pelacarsen, cardiovascular risk, cost-effectiveness
Filipova et al. (Wed,) conducted a other in Coronary Heart Disease (CHD) with elevated Lp(a) (n=597). Olpasiran and Pelacarsen vs. Standard of care alone (moderate or high intensity statin therapy) was evaluated on Quality-adjusted life years (QALYs) saved and Incremental Cost-Effectiveness Ratio (ICER). Olpasiran and pelacarsen were highly cost-effective for secondary prevention of coronary heart disease, saving 3.29 and 8.63 undiscounted QALYs respectively compared to standard of care.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: