Journal Article

Cost-effectiveness of proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab in patients with a history of myocardial infarction in Sweden

Fonarow, Gregg C, Arellano, Jorge, van Hout, Ben, Sibartie, Mahendra, Hagström, Emil, Pemberton-Ross, Peter, Villa, Guillermo, Lindgren, Peter, Landmesser, Ulf, Svensson, Maria Eriksson

2022

Overview

Abstract Aims To 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 results Cost-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. Conclusion Proprotein 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.

• Publisher: Oxford University Press
• Subject: Antibodies, Monoclonal, Humanized / Anticholesteremic Agents - therapeutic use / Cost analysis / Cost-Benefit Analysis / Cost-effectiveness / Evolocumab / Heart attacks / Humans / Low-density lipoprotein cholesterol / Monoclonal antibodies / Myocardial infarction / Myocardial Infarction - drug therapy / Myocardial Infarction - epidemiology / Original / PCSK9 inhibitors / Statins / Subtilisins / Sweden - epidemiology / Willingness to pay