Key result
For primary cardiovascular prevention, icosapent ethyl plus statin is cost-effective (ICER: 18,133 €/QALY), and for secondary prevention, ezetimibe (ICER: -9,555 €/QALY) and icosapent ethyl (ICER: 14,485 €/QALY) are cost-effective options.
Why the study?
Novel cardiovascular event-reducing treatments in dyslipidaemia must demonstrate clinical efficacy and cost-effectiveness to promote long-term adoption.
Does additive lipid-lowering therapy improve cost-effectiveness compared to statin monotherapy in patients requiring primary or secondary cardiovascular prevention?
Does additive lipid-lowering therapy improve cost-effectiveness compared to statin monotherapy in patients requiring primary or secondary cardiovascular prevention?
In the German healthcare system, icosapent ethyl and ezetimibe are highly cost-effective additions to statin therapy for cardiovascular prevention, whereas PCSK9 inhibitors have substantially higher cost-effectiveness ratios.
PURPOSE: Novel pharmaceutical treatments reducing cardiovascular events in dyslipidaemia patients must demonstrate clinical efficacy and cost-effectiveness to promote long-term adoption by patients, physicians, and insurers. OBJECTIVE: To assess the cost-effectiveness of statin monotherapy compared to additive lipid-lowering therapies for primary and secondary cardiovascular prevention from the perspective of Germany's healthcare system. METHODS: Transition probabilities and hazard ratios were derived from cardiovascular outcome trials for statin combinations with icosapent ethyl (REDUCE-IT), evolocumab (FOURIER), alirocumab (ODYSSEY), ezetimibe (IMPROVE-IT), and fibrate (ACCORD). Costs and utilities were retrieved from previous literature. The incidence of major adverse cardiovascular events was simulated with a Markov cohort model. The main outcomes were the incremental cost-effectiveness ratios (ICER) per quality adjusted life year (QALY) gained. RESULTS: For primary prevention, the addition of icosapent ethyl to statin generated 0.81 QALY and €14,732 costs (ICER: 18,133), whereas fibrates yielded 0.63 QALY and € - 10,516 costs (ICER: - 16,632). For secondary prevention, the addition of ezetimibe to statin provided 0.61 QALY at savings of € - 5,796 (ICER: - 9,555) and icosapent ethyl yielded 0.99 QALY and €14,333 costs (ICER: 14,485). PCSK9 inhibitors offered 0.55 and 0.87 QALY at costs of €62,722 and €87,002 for evolocumab (ICER: 114,639) and alirocumab (ICER: 100,532), respectively. A 95% probability of cost-effectiveness was surpassed at €20,000 for icosapent ethyl (primary and secondary prevention), €119,000 for alirocumab, and €149,000 for evolocumab. CONCLUSIONS: For primary cardiovascular prevention, a combination therapy of icosapent ethyl plus statin is a cost-effective use of resources compared to statin monotherapy. For secondary prevention, icosapent ethyl, ezetimibe, evolocumab, and alirocumab increase patient benefit at different economic costs.
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Michaeli et al. (2022) studied Dyslipidaemia (Primary and Secondary Cardiovascular Prevention). Additive lipid-lowering therapies (icosapent ethyl, evolocumab, alirocumab, ezetimibe, fibrate) plus statin vs. Statin monotherapy was evaluated on Incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained (ICER: 18,133 €/QALY for icosapent ethyl in primary prevention). For primary cardiovascular prevention, icosapent ethyl plus statin is cost-effective (ICER: 18,133 €/QALY), and for secondary prevention, ezetimibe (ICER: -9,555 €/QALY) and icosapent ethyl (ICER: 14,485 €/QALY) are cost-effective options.
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