Cost-effectiveness of cholesterol-lowering drugs for secondary cardiovascular prevention in the UK: ezetimibe, evolocumab, and alirocumab

Abstract Background Despite statin treatment, patients with elevated low-density lipoprotein cholesterol (LDL-C) levels remain at high risk for acute cardiovascular events. Ezetimibe, evolocumab, and alirocumab were consequently developed to reduce the of recurrent ischemic events in established diseases by 6%, 15%, respectively. However, these novel treatments must demonstrate both clinical efficacy cost-effectiveness promote long-term adoption patients, physicians, insurers. Objective To assess statins combination ezetimibe, secondary prevention from perspective England's National Health Service (NHS). Methods The incidence major adverse events, including, myocardial infarction, stroke, angina, coronary revascularization, was simulated a Markov cohort model. model populated transition probabilities hazard ratios derived outcome trials combinations ezetimibe (IMPROVE-IT), evolocumab (FOURIER), (ODYSSEY). Costs utilities retrieved previous literature. Principle outcomes interest incremental (ICER) per quality-adjusted life year (QALY) gained 2021 Great Britain Pounds (£). Univariate, scenario, willingness-to-pay, probabilistic sensitivity analyses conducted robustness results. Results For prevention, increased QALYs 0.60 cost reductions −£2,529 (ICER: −4,231 £/QALY) compared monotherapy. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors provided 0.53 0.86 costs £45,279 £46,375 75,283 40,708 £/QALY), At NHS' willingness-to-pay threshold 30,000 £/QALY, there is 100% probability 0% PCSK9 be cost-effective prevention. remained robust under univariate, analyses. Conclusions Ezetimibe an annual price £346 UK. inhibitors, discounts −37% −53% on alirocumab's (£4,412) evolocumab's (£4,467) prices are necessary achieve cost-effectiveness. Funding Acknowledgement Type funding sources: None.