Modelling Methods for Economic Evaluations of Non-Statin Lipid Lowering Therapies for Reducing Cardiovascular Risk: A Systematic Literature Review
Author(s)
Shantanu Jawla, MPharm1, Upasna Gaba, MPH2, Ritu Gupta, MPH2, Aastha Radotra, MPH2.
1Senior Manager HEOR & RWE, Daiichi Sankyo Europe GmbH, Munich, Germany, 2Skyward Analytics Pvt. Ltd., Gurugram, India.
1Senior Manager HEOR & RWE, Daiichi Sankyo Europe GmbH, Munich, Germany, 2Skyward Analytics Pvt. Ltd., Gurugram, India.
Presentation Documents
OBJECTIVES: Cardiovascular (CV) diseases are a leading cause of mortality, globally. While statin therapies are the first-line standard for cholesterol management leading to CV risk reduction, many patients are not able to reach their cholesterol goals or tolerate statin-related adverse effects. With increasing number of lipid-lowering therapies (LLTs), the lipid and payer community need to be able to identify and interpret the methods applied in establishing the cost-effectiveness of these therapies. Therefore, this systematic literature review (SLR) aimed to summarise and quality assess the published economic evaluations from across Europe of LLTs, among individuals at high CV risk or those with established CV disease.
METHODS: Searches were performed via Ovid (Embase, Medline, and Cochrane Library) and Google Scholar until February 08, 2023, in accordance with Cochrane guidelines. Quality assessment of included studies was performed using the 2022 Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.
RESULTS: Seventeen studies were identified, primarily conducted from a healthcare-payer perspective across Europe. Markov models were most commonly employed, with diverse time horizons (26 months to lifetime), and varying discount rates (3-5.5%). Modelled outcomes included events averted, quality-adjusted life years gained, life years gained, incremental costs, and incremental cost-effectiveness ratios. Included studies evaluated the cost-effectiveness of alirocumab, evolocumab, ezetimibe, bempedoic acid, and inclisiran, with varying outcomes and conclusions reported across studies. An assessment using the CHEERS checklist indicated that quality of studies varied, with a median score of 76%.
CONCLUSIONS: This SLR identified various decision analytical models for evaluating non-statin LLTs for managing LDL-C and CV risk, with the Markov cohort model as the most commonly employed method. Despite variations in inputs and representations of health states, the economic models shared structural similarities. These findings provide guidance for the lipid and payer community, and provide valuable insights for future research and economic model development in the CV field.
METHODS: Searches were performed via Ovid (Embase, Medline, and Cochrane Library) and Google Scholar until February 08, 2023, in accordance with Cochrane guidelines. Quality assessment of included studies was performed using the 2022 Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.
RESULTS: Seventeen studies were identified, primarily conducted from a healthcare-payer perspective across Europe. Markov models were most commonly employed, with diverse time horizons (26 months to lifetime), and varying discount rates (3-5.5%). Modelled outcomes included events averted, quality-adjusted life years gained, life years gained, incremental costs, and incremental cost-effectiveness ratios. Included studies evaluated the cost-effectiveness of alirocumab, evolocumab, ezetimibe, bempedoic acid, and inclisiran, with varying outcomes and conclusions reported across studies. An assessment using the CHEERS checklist indicated that quality of studies varied, with a median score of 76%.
CONCLUSIONS: This SLR identified various decision analytical models for evaluating non-statin LLTs for managing LDL-C and CV risk, with the Markov cohort model as the most commonly employed method. Despite variations in inputs and representations of health states, the economic models shared structural similarities. These findings provide guidance for the lipid and payer community, and provide valuable insights for future research and economic model development in the CV field.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE91
Topic
Economic Evaluation
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)