PCSK9 inhibitors not cost effective

PCSK9 inhibitors not cost effective PharmacoEconomics & Outcomes News 804, p25 - 2 Jun 2018 PCSK9 inhibitor therapy does not appear to be cost effective at current prices, according to findings of a review published in PharmacoEconomics. Embase and Medline were searched up to November 2017 for full economic studies evaluating the cost effectiveness of PCSK9 inhibitors (evolocumab and/ or alirocumab) for reducing LDL cholesterol levels and cardiovascular risk compared with statins (HMG-CoA reductase inhibitors) and/or ezetimibe. Ten studies met the selection criteria: eight from the US, one from Norway and one from Spain. The Spanish study and two US studies were Amgen-funded. Cost effectiveness was assessed over a lifetime time horizon in all studies. Five studies considered a healthcare system perspective. Other perspectives were health system and private payer (2 studies), payer (1), and societal (1). All studies were published between 2015 and 2017. In nine of the studies, estimated incremental cost- effectiveness ratios (ICERs) were above willingness-to- pay (WTP) thresholds. ICERs in the US ranged from $141 699 to $1 336 221 (2015–2017 values) per QALY gained. The exception was the study in Spain, which concluded that evolocumab was cost effective compared with statins in patients with familial hypercholesterolaemia (most of whom had established atherosclerotic cardiovascular disease), with an ICER of €30 893 (2017 values) per QALY gained. However, for secondary prevention in patients without familial hypercholesterolaemia, the ICER was €45 340 per QALY gained, which exceeded the WTP threshold in Spain (€45 000 per QALY gained). It was estimated that the prices of PCSK9 inhibitors would need to be reduced by 33%–95% to achieve cost effectiveness. "The cost effectiveness of PCSK9 inhibitors remains uncertain because only one large randomized clinical trial has reported results . . . Still, most of the studies analysed here conclude that PCSK9 inhibitors are not cost effective for most patient groups, given a threshold in the order of US$100,000 per QALY," concluded the authors. "All analysis results included in this review are highly sensitive to changes in price, such that significant price breaks lead to major reductions in ICERs and increases in likelihood of cost effectiveness. Price breaks in the order of 50–70% were necessary in most analyses for PCSK9 inhibitors to be considered cost effective at the stated WTP levels," they said. Korman MJ, et al. Are PCSK9 Inhibitors Cost Effective? PharmacoEconomics : 18 May 2018. Available from: URL: http://doi.org/10.1007/ s40273-018-0671-0 803322883 1173-5503/18/0804-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved PharmacoEconomics & Outcomes News 2 Jun 2018 No. 804 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png PharmacoEconomics & Outcomes News Springer Journals

PCSK9 inhibitors not cost effective

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Publisher
Springer International Publishing
Copyright
Copyright © 2018 by Springer International Publishing AG, part of Springer Nature
Subject
Medicine & Public Health; Pharmacoeconomics and Health Outcomes; Quality of Life Research; Health Economics; Public Health
ISSN
1173-5503
eISSN
1179-2043
D.O.I.
10.1007/s40274-018-4989-9
Publisher site
See Article on Publisher Site

Abstract

PharmacoEconomics & Outcomes News 804, p25 - 2 Jun 2018 PCSK9 inhibitor therapy does not appear to be cost effective at current prices, according to findings of a review published in PharmacoEconomics. Embase and Medline were searched up to November 2017 for full economic studies evaluating the cost effectiveness of PCSK9 inhibitors (evolocumab and/ or alirocumab) for reducing LDL cholesterol levels and cardiovascular risk compared with statins (HMG-CoA reductase inhibitors) and/or ezetimibe. Ten studies met the selection criteria: eight from the US, one from Norway and one from Spain. The Spanish study and two US studies were Amgen-funded. Cost effectiveness was assessed over a lifetime time horizon in all studies. Five studies considered a healthcare system perspective. Other perspectives were health system and private payer (2 studies), payer (1), and societal (1). All studies were published between 2015 and 2017. In nine of the studies, estimated incremental cost- effectiveness ratios (ICERs) were above willingness-to- pay (WTP) thresholds. ICERs in the US ranged from $141 699 to $1 336 221 (2015–2017 values) per QALY gained. The exception was the study in Spain, which concluded that evolocumab was cost effective compared with statins in patients with familial hypercholesterolaemia (most of whom had established atherosclerotic cardiovascular disease), with an ICER of €30 893 (2017 values) per QALY gained. However, for secondary prevention in patients without familial hypercholesterolaemia, the ICER was €45 340 per QALY gained, which exceeded the WTP threshold in Spain (€45 000 per QALY gained). It was estimated that the prices of PCSK9 inhibitors would need to be reduced by 33%–95% to achieve cost effectiveness. "The cost effectiveness of PCSK9 inhibitors remains uncertain because only one large randomized clinical trial has reported results . . . Still, most of the studies analysed here conclude that PCSK9 inhibitors are not cost effective for most patient groups, given a threshold in the order of US$100,000 per QALY," concluded the authors. "All analysis results included in this review are highly sensitive to changes in price, such that significant price breaks lead to major reductions in ICERs and increases in likelihood of cost effectiveness. Price breaks in the order of 50–70% were necessary in most analyses for PCSK9 inhibitors to be considered cost effective at the stated WTP levels," they said. Korman MJ, et al. Are PCSK9 Inhibitors Cost Effective? PharmacoEconomics : 18 May 2018. Available from: URL: http://doi.org/10.1007/ s40273-018-0671-0 803322883 1173-5503/18/0804-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved PharmacoEconomics & Outcomes News 2 Jun 2018 No. 804

Journal

PharmacoEconomics & Outcomes NewsSpringer Journals

Published: Jun 2, 2018

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