Article ; Online: Cost-Effectiveness Analysis of Evolocumab in Adult Patients with Atherosclerotic Cardiovascular Disease in Canada.
2022 Volume 39, Issue 7, Page(s) 3262–3279
Abstract: Introduction: To evaluate the cost-effectiveness of evolocumab when added to standard of care lipid-lowering treatment (LLT) for patients with atherosclerotic cardiovascular disease (ASCVD) who cannot adequately control their low-density lipoprotein ... ...
| Abstract | Introduction: To evaluate the cost-effectiveness of evolocumab when added to standard of care lipid-lowering treatment (LLT) for patients with atherosclerotic cardiovascular disease (ASCVD) who cannot adequately control their low-density lipoprotein cholesterol (LDL-C) despite optimized LLT in Canada. Methods: An incremental cost-utility analysis was conducted using a Markov cohort state transition model adapted to the Canadian setting. Analyses were conducted from a public health and societal perspective using a lifetime time horizon for Canada. Scenario analyses were conducted on the basis of recommendations from the 2021 Canadian Cardiovascular Society (CCS) dyslipidemia guidelines. Results: In ASCVD patients with prior myocardial infarction (MI) and baseline LDL-C ≥ 1.8 mmol/L, adding evolocumab to optimized statin therapy with or without ezetimibe is associated with an incremental cost per quality-adjusted life year (QALY) gained of $66,453 CAD. Furthermore, for every 100 patients treated with evolocumab for lifetime, adding evolocumab to optimized LLT will prevent approximately 52 cardiovascular (CV) events, of which seven would be fatal. The results are generally robust using univariate and simultaneous variation in model input parameters. Scenario analyses for patient populations as per the CCS guidelines suggest that evolocumab added to optimized LLT may be considered cost-effective, given an incremental cost-effectiveness ratio (ICER) threshold of CAD$100,000 per QALY gained. Limitations associated with this analysis should be interpreted in the context of data and modeling assumptions used. Conclusion: Overall, this analysis supports reimbursement of evolocumab by payers in patients with ASCVD who cannot reach LDL-C thresholds despite optimized LLT to reduce unnecessary fatal and non-fatal CV events. |
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| MeSH term(s) | Adult ; Antibodies, Monoclonal, Humanized ; Anticholesteremic Agents/therapeutic use ; Atherosclerosis/drug therapy ; Canada ; Cardiovascular Diseases/drug therapy ; Cardiovascular Diseases/prevention & control ; Cholesterol, LDL ; Cost-Benefit Analysis ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use |
| Chemical Substances | Antibodies, Monoclonal, Humanized ; Anticholesteremic Agents ; Cholesterol, LDL ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; evolocumab (LKC0U3A8NJ) |
| Language | English |
| Publishing date | 2022-05-23 |
| Publishing country | United States |
| Document type | Journal Article ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 632651-1 |
| ISSN | 1865-8652 ; 0741-238X |
| ISSN (online) | 1865-8652 |
| ISSN | 0741-238X |
| DOI | 10.1007/s12325-022-02130-4 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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