Cost-Effectiveness Analysis of Generalizing the Lp(a) Dosing in Secondary Prevention in a Population of French Patients With Cardiovascular Disease
Author(s)
Victor Vega, Pharm.D1, Anne-Sophie Moutié, Pharm.D1, Pierre-Edouard Saint-Antonin, MD1, Eric Bruckert, MD2.
1Novartis, Rueil-Malmaison, France, 2Assistance-Publique Hopitaux de Paris, Paris, France.
1Novartis, Rueil-Malmaison, France, 2Assistance-Publique Hopitaux de Paris, Paris, France.
OBJECTIVES: A high rate of Lipoprotein(a) [Lp(a)], primarily of genetic origin, is a risk factor (RF) for cardiovascular diseases (CVD). Its measurement is not reimbursed in France. This study models the impact of risk awareness associated with Lp(a) through a dosage on proactive management of other RFs in order to evaluate the cost-effectiveness ratio of generalizing the Lp(a) dosing in a French population affected by CVD.
METHODS: The economic model relies on a decision tree followed by Markov model. Modeling of clinical outcome is based on risk equations for a cardiovascular event (myocardial infarction, stroke, MACE), estimated from data of patients from the UK-Biobank. It is recognized that knowledge of a genetic factor improves patient management, and that risk communication results in a reduction of RFs (particularly LDL-c and blood pressure). Various reductions estimated from published meta-analyses were tested, with a 5% LDL-c reduction as basecase analysis. The clinical outcomes and costs, with and without Lp(a) screening, are compared in this study, over a lifetime horizon.
RESULTS: The generalization of Lp(a) dosing is a dominant strategy. In the basecase analysis, it could prevent 24 events per 10,000 patients tested, increasing the quality of life of patients and avoiding associated costs, which compensate for the additional cost of the dosing. Extensive sensitivity analysis testing various changes in RFs support the basecase results.
CONCLUSIONS: The generalization of Lp(a) dosing facilitated by reimbursement and awareness of the increased risk appears to be a cost-effective strategy. It would improve morbidity and mortality and the quality of life of patients and would result in savings for the health care system. However, in the absence of specific therapeutic alternatives, there remains a significant medical need to directly reduce Lp(a).
METHODS: The economic model relies on a decision tree followed by Markov model. Modeling of clinical outcome is based on risk equations for a cardiovascular event (myocardial infarction, stroke, MACE), estimated from data of patients from the UK-Biobank. It is recognized that knowledge of a genetic factor improves patient management, and that risk communication results in a reduction of RFs (particularly LDL-c and blood pressure). Various reductions estimated from published meta-analyses were tested, with a 5% LDL-c reduction as basecase analysis. The clinical outcomes and costs, with and without Lp(a) screening, are compared in this study, over a lifetime horizon.
RESULTS: The generalization of Lp(a) dosing is a dominant strategy. In the basecase analysis, it could prevent 24 events per 10,000 patients tested, increasing the quality of life of patients and avoiding associated costs, which compensate for the additional cost of the dosing. Extensive sensitivity analysis testing various changes in RFs support the basecase results.
CONCLUSIONS: The generalization of Lp(a) dosing facilitated by reimbursement and awareness of the increased risk appears to be a cost-effective strategy. It would improve morbidity and mortality and the quality of life of patients and would result in savings for the health care system. However, in the absence of specific therapeutic alternatives, there remains a significant medical need to directly reduce Lp(a).
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE202
Topic
Clinical Outcomes, Economic Evaluation, Epidemiology & Public Health
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)