Cost-Effectiveness of Icosapent Ethyl, Evolocumab, Alirocumab, Ezetimibe, or Fenofibrate in Combination with Statins Compared to Statin Monotherapy

Background Despite treatment with statins, dyslipidaemia patients with elevated cholesterol- and triglyceride-levels remain at high residual risk for major adverse cardiovascular events (MACE). New lipid-lowering drugs must prevent the occurrence of MACE and exhibit cost-effectiveness for their successful adoption to clinical practice. Objective To assess the cost effectiveness of icosapent ethyl, fenofibrate, ezetimibe, evolocumab, and alirocumab in combination with statins compared to statin monotherapy for cardiovascular prevention from the perspective of UK's National Health Service. Methods A Markov model simulated the progression of cardiovascular disease and MACE, including myocardial infarction, stroke, angina pectoris, and coronary revascularisation, in dyslipidaemia patients. The model was populated with cardiovascular outcome trial data for each drug. Cost and utility data were extracted from peer-reviewed literature. The incremental cost-effectiveness ratio (ICER) is reported per quality-adjusted life years (QALY) gained in 2021 Great Britain Pounds () pound. Results For primary cardiovascular prevention, icosapent ethyl increased QALYs by 0.79 and costs by 15,421 pound compared to statin monotherapy (ICER = 19,485 pound/QALY). Fenofibrate yielded 0.62 additional QALYs at cost-savings of - 6127 pound (ICER = - 9932 pound/QALY). For secondary prevention, the omega-3 fatty acid icosapent ethyl extended QALYs by 0.98 at costs of 12,981 pound compared to statin monotherapy (ICER = 13,285 pound/QALY). Fenofibrate added 0.85 QALYs whilst saving - 637 pound (ICER = - 7472 pound/QALY). Ezetimibe increased QALYs by 0.60 at cost reductions of - 2529 pound (ICER = - 4231 pound/QALY). PCSK9 inhibitors provided QALYs of 0.53 and 0.86 at costs of 45,279 pound and 46,375 pound for evolocumab (ICER = 85,193 pound/ QALY) and alirocumab (ICER = 54,211 pound/QALY), respectively. At a willingness-to-pay threshold of 25,000 pound/QALY, there is a probability of 100% for icosapent ethyl (98% in primary prevention) and 0% for PCSK9 inhibitors to be cost effective in secondary prevention. Conclusions Icosapent ethyl is cost effective for primary and secondary cardiovascular prevention at an annual price of 2064 pound in the UK. For PCSK9 inhibitors, price discounts or prescription restrictions are necessary to achieve cost effectiveness. [GRAPHICS] .

Automated summary

This study assessed the cost effectiveness of icosapent ethyl, fenofibrate, ezetimibe, evolocumab, and alirocumab in combination with statins compared to statin monotherapy for cardiovascular prevention. The results showed that icosapent ethyl was cost effective in both primary and secondary cardiovascular prevention, while price discounts or prescription restrictions were necessary for PCSK9 inhibitors to achieve cost effectiveness.