Cost-Effectiveness of Icosapent Ethyl, Evolocumab, Alirocumab, Ezetimibe, or Fenofibrate in Combination with Statins Compared to Statin Monotherapy

Figures

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  Fig. 1. Markov model structure of cardiovascular diseases progression and acute events. Patients commence the model in the “Alive without CVD” (primary prevention) or “Alive with CVD” (secondary prevention) state. Every year patients were at risk of experiencing acute cardiovascular events (myocardial infarction, stroke, coronary revascularisation, unstable angina pectoris) and dying from CVD or non-CVD causes. Model structure adopted from Michaeli et al. [23]. CVD cardiovascular disease

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  Fig. 2. Cost-effectiveness plane for ezetimibe, evolocumab, alirocumab, icosapent ethyl, and fenofibrate in combination with statins for primary (A) and secondary (B) cardiovascular prevention. QALYs and costs presented for the average person simulated in the model. Lipid-lowering drugs are presented as cholesterol-and triglyceride-lowering according to guideline recommendations [11]. Costs in 2021 Great Britain Pounds (£). QALY quality-adjusted life year

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  Fig. 3. Probabilistic sensitivity analysis for ezetimibe, evolocumab, alirocumab, icosapent ethyl, and fenofibrate in combination with statins for primary (A) and secondary (B) cardiovascular prevention. Input parameters displayed in Table 1 were varied by their confidence intervals and distribution; 1000 simulations of this probabilistic sensitivity analysis are visualised in this Figure. The grey line illustrates the English NHS’ upper willingness-to-pay threshold of £30,000 per QALY. Lipid-lowering drugs are presented as cholesterol- and triglyceride-lowering according to guideline recommendations [11]. QALYs and costs presented for the average person simulated in the model. Costs in 2021 Great Britain Pounds (£). ICER incremental cost-effectiveness ratio, NHS National Health Service, QALY quality-adjusted life year

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  Fig. 4. Probability of cost effectiveness at different willingness-to-pay thresholds for ezetimibe, evolocumab, alirocumab, icosapent ethyl, and fenofibrate in combination with statins for primary (A) and secondary (B) cardiovascular prevention. The grey line illustrates the English NHS’ upper willingness-to-pay threshold of £30,000 per QALY. Dotted lines show the willingness-to-pay thresholds at which the probability of cost-effectiveness surpasses 95%. Lipid-lowering drugs are presented as cholesterol-and triglyceride-lowering according to guideline recommendations [11]. QALYs and costs presented for the average person simulated in the model. Costs in 2021 Great Britain Pounds (£) and willingness-to-pay thresholds in £/QALY. NHS National Health Service, QALY quality-adjusted life year