| Title: | Rethinking cardiovascular prevention: cost-effective cholesterol lowering for statin-intolerant patients in Australia and the UK |
| Journal: | European Journal of Preventive Cardiology |
| Published: | 21 Mar 2025 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/40112156/ |
| DOI: | https://doi.org/10.1093/eurjpc/zwaf114 |
Publication 15922
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Abstract
AIMS: Approximately 1 in 11 people are intolerant to statins. There have been no studies evaluating the cost-effectiveness of early intervention for primary prevention of cardiovascular disease (CVD) with three non-statin drugs [ezetimibe, proprotein convertase subtilisin-kexin type 9 inhibitors (PCSK9i; inclisiran and evolocumab), and bempedoic acid]. We aimed to evaluate the cost-effectiveness of these therapies when initiated at age 40 years.</p>
METHODS AND RESULTS: We used a published microsimulation model populated with 108 statin-intolerant individuals. The model simulated the ageing of individuals from 40 to 85 years. We calculated the incremental cost-effectiveness ratio when non-statin lipid-lowering strategies were initiated at age 40 years compared to no intervention until a cardiovascular event. Incremental cost-effectiveness ratios were compared to Australian and UK cost-effectiveness thresholds of 28 000 AUD and 25 000 GBP per quality adjusted life year gained, respectively. We adopted each countries national healthcare system perspective (2022 AUD/GBP) and discounted health economic results by 5% annually for Australia and 3.5% annually for the UK. At current prices in Australia, ezetimibe was cost-effective in 34/108 (31.4%) individuals simulated; bempedoic acid in 17/108 (15.7%); bempedoic acid and ezetimibe in combination in 14/108 (13.0%); while inclisiran and evolocumab were not cost-effective in any individuals. Corresponding numbers for the UK were 98/108 (90.7%); 5/108 (4.6%); 11/108 (10.2%); 0/108 (0.0%); and 0/108 (0.0%). Cost-effectiveness of bempedoic acid was predominantly among individuals with an LDL-C of at least 4.0 mmol/L and systolic blood pressure of at least 140 mmHg in Australia and 5.0 mmol/L and 160 mmHg in the UK, respectively.</p>
CONCLUSION: Ezetimibe and bempedoic acid, both alone and in combination, are cost-effective for long-term primary prevention of CVD in a range of people with statin intolerance, depending on their baseline risk of CVD.</p>
26 Keywords
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized
- Anticholesteremic Agents
- Australia
- Biomarkers
- Cardiovascular Diseases
- Cholesterol, LDL
- Cost-Benefit Analysis
- Dicarboxylic Acids
- Drug Costs
- Ezetimibe
- Fatty Acids
- Female
- Humans
- Hydroxymethylglutaryl-CoA Reductase Inhibitors
- Male
- Middle Aged
- Models, Economic
- PCSK9 Inhibitors
- Primary Prevention
- Quality-Adjusted Life Years
- Time Factors
- Treatment Outcome
- United Kingdom
7 Authors
- Jedidiah I Morton
- Danny Liew
- Gerald F Watts
- Sophia Zoungas
- Stephen J Nicholls
- Padraig Dixon
- Zanfina Ademi
1 Application
| Application ID | Title |
|---|---|
| 88775 | A novel approach integrating genomics into the health economic modelling of therapeutics |
Enabling scientific discoveries that improve human health