Preview

PDF, English - main document Download (6MB) | Terms of use

Abstract

Despite treatment with statins, dyslipidemia patients with elevated cholesterol- and triglyceride levels remain at high residual risk for major adverse cardiovascular events (MACE). New additive lipid-lowering drugs emerged to prevent the occurrence of MACE. These novel pharmaceutical treatments must not only demonstrate clinical efficacy and safety, but also cost-effectiveness to promote long-term adoption by patients, physicians, and insurers. This study evaluates the cost-effectiveness of additive lipid-lowering agents compared to statin monotherapy for primary and secondary cardiovascular prevention in Germany and the UK. A Markov model was developed to simulate the progression of cardiovascular diseases and MACE, including myocardial infarction, stroke, angina pectoris, and coronary revascularization, in dyslipidemia patients. The model was populated with transition probabilities and hazard ratios from cardiovascular outcome trials for statins in combination with icosapent ethyl (REDUCE-IT), evolocumab (FOURIER), alirocumab (ODYSSEY), ezetimibe (IMPROVE-IT), and fibrate (ACCORD). Cost and utility data were extracted from peer-reviewed literature. For primary and secondary cardiovascular prevention, combination therapy of icosapent ethyl and statin is a cost-effective use of resources compared to statin monotherapy in Germany and the UK. For the PCSK9 inhibitors evolocumab and alirocumab, price discounts or prescription restrictions are necessary to achieve cost-effectiveness in the UK. Ezetimibe and fenofibrate are low-cost generics that lower the risk of ischaemic cardiovascular events, while potentially providing savings for the healthcare system.