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Vascul Pharmacol. 2019 Sep;120:106566. doi: 10.1016/j.vph.2019.106566. Epub 2019 Jun 14.

Cost effectiveness of lifelong therapy with PCSK9 inhibitors for lowering cardiovascular events in patients with stable coronary artery disease: Insights from the Ludwigshafen Risk and Cardiovascular Health cohort.

Author information

1
DACH Society for the Prevention of Cardiovascular Disease e.V., Schulterblatt 120, 20357 Hamburg, Germany.
2
Applied University Fresenius Heidelberg, Germany.
3
Klinik und Poliklinik für Kardiologie, Universität Leipzig, Germany.
4
SYNLAB Academy, SYNLAB Holding Germany GmbH, P5, 7, 68167 Mannheim, Germany.
5
National Institute for Health and Medical Research (INSERM), Sorbonne University, Pitie-Salpetriere Hospital, Paris, France; Baker Heart and Diabetes Institute, Melbourne, Australia.
6
Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Germany. Electronic address: tanja.grammer@medma.uni-heidelberg.de.
7
SYNLAB Academy, SYNLAB Holding Germany GmbH, P5, 7, 68167 Mannheim, Germany; Department of Internal Medicine V (Nephrology, Hypertension, Rheumatology, Endocrinology, Diabetology), Mannheim Medical Faculty, University of Heidelberg, Germany; Clinical Institute for Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbrugger Platz, A-8036 Graz, Austria.

Abstract

Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) reduce cardiovascular events in coronary artery disease (CAD). Their costs exceed that of established oral lipid-lowering agents. Previous cost-effectiveness assessments have been inconsistent. Markov cohort state transitions models for stable CAD patients were calculated using information from 1530 participants of the Ludwigshafen Risk and Cardiovascular Health Study (LURIC) with known causes of deaths. Non-fatal to fatal event rates, drug prices, direct treatment costs, and utility weights were from public sources. At an assumed relative risk reduction of 32.5% and an annual drug price of 8500 Euros, QALYs gained were 1.23 and 1.20, savings were 2390 and 2410 Euros, and ICERs were 112,530 and 108,660 Euros in women and men, respectively. When the annual cost of this medication was set at 1600 Euros, corresponding ICERs were 21,180 and 20,450 Euros. PCSK9i treatment is cost-effective in stable CAD at a threshold of 150,000 Euro and annual costs of 8500 Euros. As the broad use of PCSK9i therapy in CAD would have a disruptive impact on the healthcare budget, treatment should be focused on very high risk patients (≥3 comorbidities, annual risk of 10%); alternatively, and for lower risk, significant cost reductions would be needed.

KEYWORDS:

Cardiovascular risk; Coronary heart disease; Cost-effectiveness; Incremental cost-effectiveness ratio (ICER); LDL cholesterol; Proprotein convertase subtilisin/kexin type 9 (PCSK9); Quality Adjusted Life Years (QALYs)

PMID:
31207358
DOI:
10.1016/j.vph.2019.106566

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