Comparison of Nonstatin Lipid-Lowering Therapies (LLTs) by Their Annual Cost per Effectively Treated Very High-Risk Patient in Spain
Author(s)
Mónica Climente Martí, PharmD1, Xandra García-González, PharmD2, Francisco Ignacio Torres-Bondia, PharmD3, Javier Lozano, BSc4, Vanessa Gómez, MBA4.
1Servicio de Farmacia Hospitalaria, Hospital Universitario Dr. Peset, Valencia, Spain, 2Servicio de Farmacia Hospitalaria, Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain, 3Servicio de Farmacia Hospitalaria, Hospital Universitario de Santa Maria - Hospital Universitario Arnau de Vilanova, Lleida, Spain, 4Amgen S.A., Barcelona, Spain.
1Servicio de Farmacia Hospitalaria, Hospital Universitario Dr. Peset, Valencia, Spain, 2Servicio de Farmacia Hospitalaria, Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain, 3Servicio de Farmacia Hospitalaria, Hospital Universitario de Santa Maria - Hospital Universitario Arnau de Vilanova, Lleida, Spain, 4Amgen S.A., Barcelona, Spain.
OBJECTIVES: To perform a comparative cost-effectiveness analysis of non-statin LLTs for patients categorized at very high risk of recurrent cardiovascular events (CVEs) in Spain.
METHODS: Using a Monte Carlo simulation, we modelled the low-density lipoprotein cholesterol (LDL-C) baseline levels of 2,000 Spanish patients in secondary CVE prevention and identified patients at very high-risk based on baseline LDL-C levels exceeding 100 mg/dL (eligibility criterion for local reimbursement). We assessed the percentages of these patients effectively treated, i.e. achieving LDL-C <55 mg/dL and ≥50% LDL‑C reduction from baseline, according to 2019 ESC/EAS treatment guidelines. The modeling LLT scenarios considered their literature-reported relative efficacy. The annual cost per effectively treated patient was estimated in different time scenarios (years 1 to 5 on average) based on local annual treatment costs and the estimation of percentages of very high-risk patients effectively treated.
RESULTS: Evolocumab 140 mg every 2 weeks (Q2W), followed by alirocumab 150 mg Q2W were modelled as the most cost-effective non‑statin LLTs, with 80% and 70% of patients treated effectively, and 6,200.1€ and 7,126.5€ of annual cost per effectively treated patient, respectively. Modelled results for alirocumab 75 mg Q2W, alirocumab 300 mg monthly doses, and inclisiran were limited in magnitude, with only 33%, 26%, and 20% of patients treated effectively, respectively, and with annual costs per effectively treated patient of 15,159.1€, 19,254.9€ and 31,329.1€, respectively. Despite the dose reduction of inclisiran in maintenance therapy, the estimated annual treatment costs were 26,107.6€ and 22,974.7€ over the first 2 and 5 years, respectively.
CONCLUSIONS: Compared to other LLTs used in the secondary prevention setting, adding evolocumab 140 mg Q2W to background statins resulted in the highest proportion (80%) of very high-risk patients (with baseline LDL-C >100 mg/dL) achieving the 2019 ESC/EAS LDL-C targets in our simulation, and was associated with the lowest mean cost per patient effectively treated (6,200.1€).
METHODS: Using a Monte Carlo simulation, we modelled the low-density lipoprotein cholesterol (LDL-C) baseline levels of 2,000 Spanish patients in secondary CVE prevention and identified patients at very high-risk based on baseline LDL-C levels exceeding 100 mg/dL (eligibility criterion for local reimbursement). We assessed the percentages of these patients effectively treated, i.e. achieving LDL-C <55 mg/dL and ≥50% LDL‑C reduction from baseline, according to 2019 ESC/EAS treatment guidelines. The modeling LLT scenarios considered their literature-reported relative efficacy. The annual cost per effectively treated patient was estimated in different time scenarios (years 1 to 5 on average) based on local annual treatment costs and the estimation of percentages of very high-risk patients effectively treated.
RESULTS: Evolocumab 140 mg every 2 weeks (Q2W), followed by alirocumab 150 mg Q2W were modelled as the most cost-effective non‑statin LLTs, with 80% and 70% of patients treated effectively, and 6,200.1€ and 7,126.5€ of annual cost per effectively treated patient, respectively. Modelled results for alirocumab 75 mg Q2W, alirocumab 300 mg monthly doses, and inclisiran were limited in magnitude, with only 33%, 26%, and 20% of patients treated effectively, respectively, and with annual costs per effectively treated patient of 15,159.1€, 19,254.9€ and 31,329.1€, respectively. Despite the dose reduction of inclisiran in maintenance therapy, the estimated annual treatment costs were 26,107.6€ and 22,974.7€ over the first 2 and 5 years, respectively.
CONCLUSIONS: Compared to other LLTs used in the secondary prevention setting, adding evolocumab 140 mg Q2W to background statins resulted in the highest proportion (80%) of very high-risk patients (with baseline LDL-C >100 mg/dL) achieving the 2019 ESC/EAS LDL-C targets in our simulation, and was associated with the lowest mean cost per patient effectively treated (6,200.1€).
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE143
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis, Thresholds & Opportunity Cost
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas