1. Cost-effectiveness of PCSK9 inhibition with evolocumab in patients with a history of myocardial infarction in Sweden
- Author
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Landmesser, Ulf, Lindgren, Peter, Hagström, Emil, van Hout, Ben, Villa, Guillermo, Pemberton-Ross, Peter, Arellano, Jorge, Svensson, Maria Eriksson, Sibartie, Mahendra, and Fonarow, Gregg C
- Subjects
Clinical Research ,Cost Effectiveness Research ,Patient Safety ,Heart Disease - Coronary Heart Disease ,Comparative Effectiveness Research ,Heart Disease ,Cardiovascular ,Good Health and Well Being ,Antibodies ,Monoclonal ,Humanized ,Anticholesteremic Agents ,Cost-Benefit Analysis ,Humans ,Myocardial Infarction ,Subtilisins ,Sweden ,Cost-effectiveness ,Evolocumab ,Low-density lipoprotein cholesterol ,Myocardial infarction ,PCSK9 inhibitors ,Statins - Abstract
AimsTo assess the cost-effectiveness of proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab added to standard-of-care lipid-lowering treatment [maximum tolerated dose (MTD) of statin and ezetimibe] in Swedish patients with a history of myocardial infarction (MI).Methods and resultsCost-effectiveness was evaluated using a Markov model based on Swedish observational data on cardiovascular event rates and efficacy from the FOURIER trial. Three risk profiles were considered: recent MI in the previous year; history of MI with a risk factor; and history of MI with a second event within 2 years. For each population, three minimum baseline low-density lipoprotein cholesterol (LDL-C) levels were considered: 2.5 mmol/L (≈100 mg/dL), based on the current reimbursement recommendation in Sweden; 1.8 mmol/L (≈70 mg/dL), based on 2016 ESC/EAS guidelines; and 1.4 mmol/L (≈55 mg/dL), or 1.0 mmol/L (≈40 mg/dL) for MI with a second event, based on 2019 ESC/EAS guidelines. Proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab was associated with increased quality-adjusted life-years and costs vs. standard-of-care therapy. Incremental cost-effectiveness ratios (ICERs) were below SEK700 000 (∼€66 500), the generally accepted willingness-to-pay threshold in Sweden, for minimum LDL-C levels of 2.3 (recent MI), 1.7 (MI with a risk factor), and 1.7 mmol/L (MI with a second event). Sensitivity analyses demonstrated that base-case results were robust to changes in model parameters.ConclusionProprotein convertase subtilisin/kexin type 9 inhibition with evolocumab added to MTD of statin and ezetimibe may be considered cost-effective at its list price for minimum LDL-C levels of 1.7-2.3 mmol/L, depending on risk profile, with ICERs below the accepted willingness-to-pay threshold in Sweden.
- Published
- 2022