Cost-effectiveness and cost-utility study of hypercholesterolemia treatment in Spain: evolocumab added to standard of care vs standard of care.

Imedio Cerezo, Beatriz

Cost-effectiveness and cost-utility study of hypercholesterolemia treatment in Spain: evolocumab added to standard of care vs standard of care.

Citation

Imedio Cerezo, B. Cost-effectiveness and cost-utility study of hypercholesterolemia treatment in Spain: evolocumab added to standard of care vs standard of care.. 2022. handle: http://hdl.handle.net/10230/52487

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Abstract

Background. Cardiovascular diseases have a significant economic burden on healthcare systems. Effective treatments for hypercholesterolemia are available, with statins being currently the standard of care. A PCSK9 inhibitor, evolocumab, has also shown efficacy in reducing cardiovascular events in these patients. This study evaluates the cost-effectiveness and cost-utility of evolocumab with standard of care vs standard of care alone from the perspective of the Spanish National Health System (sNHS).Methods.A 20 years Markov model, based on a Markov chain developed including estimates of effectiveness, progression-free life years, quality-adjusted life years and costs. Monthly cycles were used to fit the disease course. Outcome measures were avoided cardiovascular events, life years and quality-adjusted life years (QALYs). Finally, a Monte Carlo simulation to manage uncertainty was employed and an acceptability curve was presented.Results. The incremental cost-effectiveness and incremental utility cost ratios per patient obtained were 59.895,20 €per life year free of progression and 289.677,66 €per QALY gained, respectively. The ratios obtained for the standard of care and for evolocumab added to the standard of care in that order were 191.73€and 7,238.04€per progression-free life year and 141.04€and 5,916.71€per quality-adjusted life year gained.Conclusions. In light of these results, and assuming a reference threshold of €30,000/QALY for the sNHS, adding evolocumab to standard treatment is not cost-effective when compared to standard treatment alone. However, these results should be interpreted with caution, as evolocumab may still provide cost effective value in some specific subgroups of patients. Even if no explicit cost-effectiveness threshold is used in Spain to decide funding and/or pricing levels, this work may contribute to inform decision-making in our setting.