Daniel Tobias Michaeli1,2, Julia Caroline Michaeli3,4, Tobias Boch5,6,7, Thomas Michaeli3,6,7. 1. Fifth Department of Medicine, University Hospital Mannheim, Heidelberg University, Mannheim, Germany. danielmichaeli@yahoo.com. 2. Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany. danielmichaeli@yahoo.com. 3. Fifth Department of Medicine, University Hospital Mannheim, Heidelberg University, Mannheim, Germany. 4. Department of Obstetrics and Gynecology, Asklepios-Clinic Hamburg Altona, Asklepios Hospital Group, Hamburg, Germany. 5. Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany. 6. Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. 7. Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.
Abstract
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.
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.
Authors: Catherine G Derington; Adam P Bress; Jennifer S Herrick; Wenjun Fan; Nathan D Wong; Katherine E Andrade; Jonathan Johnson; Sephy Philip; David Abrahamson; Lixia Jiao; Deepak L Bhatt; William S Weintraub Journal: Am J Prev Cardiol Date: 2022-04-28
Authors: Julia Caroline Michaeli; Thomas Michaeli; Daniel Tobias Michaeli; Sophia Stoycheva; Simon Mashudu Marcus; Wenjia Zhang Journal: Clin Drug Investig Date: 2022-03-16 Impact factor: 2.859