期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 75, 期 18, 页码 2297-2308出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2020.03.029
关键词
acute coronary syndromes; alirocumab; cholesterol; cost-effectiveness; economic analysis
资金
- Sanofi
- Regeneron Pharmaceuticals, Inc.
- Fondation Assistance Publique-Hopitaux de Paris (Paris, France)
- Edwards
- Daiichi-Sankyo
- Boehringer Ingelheim
- CSL Behring
- Ferring Pharmaceuticals
- Bayer
- Abbott
- Afimmune
- Amarin
- Amgen
- AstraZeneca
- Bristol-Myers Squibb
- Cardax
- Chiesi
- Eisai
- Ethicon
- Forest Laboratories
- Fractyl
- Idorsia
- Ironwood
- Ischemix
- Lexicon
- Lilly
- Medtronic
- Pfizer
- PhaseBio
- PLx Pharma
- Regeneron
- Roche
- Synaptic
- The Medicines Company
- Abbott Vascular
- Alexion
- Amylin Pharmaceuticals
- Janssen RD
- Lundbeck Pharmaceuticals
- Genzyme
- Merck Co.
- MonterisTESARO
- Food and Drug Administration
- Medical Device Innovation Consortium
- DalCor
- Esperion
- Bayer Healthcare
- DalCor Pharmaceuticals
- Population Health Research Institute
- Duke Clinical Research Institute
- TIMI group
- Cirius
- Montreal Health Innovations Coordinating Center
- Lepetit
- Luitpold Pharmaceuticals
- Merck
- Servier
- Novartis
- Regeneron Pharmaceuticals
- Eli Lilly
- Tenax Therapeutics
- Janssen
- Netherlands Heart Foundation
- Interuniversity Cardiology Institute of the Netherlands
- European Commission Seventh Framework Programme
- Astellas
- Athera
- Biotronik
- Boston Scientific
- Merck-Schering-Plough
- CardioVascular Research of the Netherlands
- Afferent
- Apple
- Cardiva Medical
- Johnson and Johnson
- Luitpold
- National Institutes of Health
- St. Jude Medical
- Patient Centered Outcomes Research Institute
- Myokardia
- Familial Hypercholesterolemia Foundation
- GlaxoSmithKline
BACKGROUND Cholesterol reduction with proprotein convertase subtitisin-kexin type 9 inhibitors reduces ischemic events; however, the cost-effectiveness in statin-treated patients with recent acute coronary syndrome remains uncertain. OBJECTIVES This study sought to determine whether further cholesterol reduction with atirocumab would be cost-effective in patients with a recent acute coronary syndrome on optimal statin therapy. METHODS A cost-effectiveness model leveraging patient-level data from ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Atirocumab) was developed to estimate costs and outcomes over a lifetime horizon. Patients (n = 18,924) had a recent acute coronary syndrome and were on high-intensity or maximum-tolerated statin therapy, with a baseline tow-density lipoprotein cholesterol (LDL-C) level >= 70 mg/l, non-high-density lipoprotein cholesterol >= 100 mg/dl, or apotipoprotein B >= 80 mg/l. Atirocumab 75 mg or placebo was administered subcutaneously every 2 weeks. Atirocumab was blindly titrated to 150 mg if LDL-C remained >= 50 mg/dl or switched to placebo if 2 consecutive LDL-C levels were <15 mg/dl. Incremental cost per quality-adjusted life-year (QALY) was determined with the addition of atirocumab versus placebo and, based on clinical efficacy findings from the trial, was stratified by baseline LDL-C levels -100 mg/dt and >= 100 mg/dl. RESULTS Across the overall population recruited to the ODYSSEY OUTCOMES trial, using an annual treatment cost of US$5,850, the mean overall incremental cost-effectiveness ratio was US$92,200 per QALY (base case). The cost was US$41,800 per QALY in patients with baseline LDL-C >= 100 mg/dl, whereas in those with LDL-C >= 100 mg/dl the cost per QALY was US$299,400. Among patients with LDL-C a100 mg/dl, incremental cost-effectiveness ratios remained below US$100,000 per QALY across a wide variety of sensitivity analyses. CONCLUSIONS In patients with a recent acute coronary syndrome on optimal statin therapy, atirocumab improves cardiovascular outcomes at costs considered intermediate value, with good value in patients with baseline LDL-C mg/dt but less economic value with LDL-C >= 100 mg/dl. (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Atirocumab [ODYSSEY OUTCOMES]; NCT01663402) (J Am Colt Cardiol 2020;75:2297-308) (C) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
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