Cost-Effectiveness of Alirocumab in Combination With High-Intensity Statin and Ezetimibe in Adults With Atherosclerotic Cardiovascular Disease (ASCVD) in Taiwan

OBJECTIVES: ASCVD is a global major health issue and a leading cause of mortality in Taiwan. Managing LDL-C through lipid-lowering agents is a key strategy to prevent cardiovascular events. Nonetheless, many ASCVD patients on statins still fail to achieve LDL-C levels recommended by guidelines. PCSK9 inhibitors have demonstrated efficacy in reducing LDL-C level and risk of subsequent cardiovascular events. This study evaluated the cost-effectiveness of alirocumab as an adjunct to high-intensity statins plus ezetimibe in patients with a history of ASCVD within the past 24 months from the Taiwanese healthcare payer’s perspective.

METHODS: A lifetime Markov model was employed for the analysis. Adults experienced ASCVD (i.e. myocardial infarction, unstable angina, percutaneous coronary intervention, or coronary artery bypass graft) within 24 months and had LDL-C level exceeding 100 mg/dL despite treated with statin and ezetimibe were the target population. Baseline characteristics (including age, gender, diabetes history, LDL-C levels), and CV event rates of the target population were obtained from National Health Insurance Research Database (NHIRD) from 2020 to 2023. Efficacy of alirocumab was sourced from literature, with utility inputs from literature. Direct medical costs for CV events were calculated using NHIRD data, with 2024 as the price year. A 3% annual discount rate applied to both costs and effectiveness measures.

RESULTS: Compared to the regimen of high-intensity statin plus ezetimibe, incorporation of alirocumab resulted in an incremental cost of €30,867 and an additional gain of 0.885 quality-adjusted life years (QALYs) for the target population. This corresponds to an incremental cost-effectiveness ratio (ICER) of € 34,879 per QALY gained, which is considered as cost-effective in 46.2% of the model iterations at the willingness-to-pay (WTP) thresholds of €57,596 (twice Taiwan’s GDP per capita in 2023).

CONCLUSIONS: For Taiwanese post-ASCVD event patients, alirocumab with statins and ezetimibe may be cost-effective.