Simulation of the Impact on LDLC Targets and Treatment Cost in High and Very High Cardiovascular Risk Patients of Cost-Based Sequencing of Lipid-Lowering Therapy
Author(s)
Maria Reyes Abad, PhD1, Juan Sales, PhD2, Eder Iglesias, MsC3, José Prieto, PhD4, José Conde, PhD5.
1Servicio de Farmacia, Hospital Universitario Miguel Servet. Zaragoza. España, Zaragoza, Spain, 2Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, España, Valencia, Spain, 3Daiichi Sankyo España, Madrid, Spain, 4Hospital La Paz-Carlos III, Madrid, Spain, 5Servicio de Farmacia Hospitalaria, Hospital Universitario Nuestra Señora de Candelaria de Tenerife, Santa Cruz de Tenerife, España, Santa Cruz de Tenerife, Spain.
1Servicio de Farmacia, Hospital Universitario Miguel Servet. Zaragoza. España, Zaragoza, Spain, 2Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, España, Valencia, Spain, 3Daiichi Sankyo España, Madrid, Spain, 4Hospital La Paz-Carlos III, Madrid, Spain, 5Servicio de Farmacia Hospitalaria, Hospital Universitario Nuestra Señora de Candelaria de Tenerife, Santa Cruz de Tenerife, España, Santa Cruz de Tenerife, Spain.
OBJECTIVES: To evaluate the clinical and economic impact of lipid-lowering treatment escalation algorithms including bempedoic acid (BA) in high or very high cardiovascular risk patients not achieving LDL-C targets in Spain.
METHODS: A Monte Carlo simulation was applied to real-world data from Spanish adults with high or very high cardiovascular risk and uncontrolled LDL-C despite at least 4 weeks of statin treatment with or without ezetimibe (EZE). Patients without LDL-C results, already on BA, PCSK9i (alirocumab or evolocumab) or inclisiran (INC), or who had achieved LDL-C targets were excluded. The database covered October 2022 to September 2023. LDL-C lowering efficacy was based on published evidence. Annual pharmacological costs were calculated using public prices. Five therapeutic algorithms were tested: (S1) EZE followed by PCSK9i; (S2) EZE followed by INC; (S3) EZE followed by BA and PCSK9i; (S4) EZE followed by BA and INC; (S5) EZE followed by BA, INC, and then a PCSK9i.
RESULTS: The study cohort comprised 34,967 patients, with 29% high-risk and 71% very high-risk. Mean ± standard deviation baseline LDL-C was 109±40 mg/dL. All algorithms including a PCSK9i achieved LDL-C control in 98% of patients, whereas those without it achieved it in 88%. The annual cost per treated patient was the highest in the algorithm S1 (€5,635), followed by S2 (€4,316; -23%), S3 (€3,955; -30%), S5 (€3,339; -41%), and S4 (€3,142; -44%). Introducing BA prior to injectable therapies resulted in significant cost reductions while achieving the same level of control as with algorithms that do not include BA.
CONCLUSIONS: In patients with high or very high cardiovascular risk not controlled with statins and EZE, early inclusion of BA in treatment algorithms can achieve a similar share of patients with controlled LDL-C levels as PSK9 therapy, while significantly reducing budget impact. Cost-based sequencing provides an efficient approach for healthcare systems.
METHODS: A Monte Carlo simulation was applied to real-world data from Spanish adults with high or very high cardiovascular risk and uncontrolled LDL-C despite at least 4 weeks of statin treatment with or without ezetimibe (EZE). Patients without LDL-C results, already on BA, PCSK9i (alirocumab or evolocumab) or inclisiran (INC), or who had achieved LDL-C targets were excluded. The database covered October 2022 to September 2023. LDL-C lowering efficacy was based on published evidence. Annual pharmacological costs were calculated using public prices. Five therapeutic algorithms were tested: (S1) EZE followed by PCSK9i; (S2) EZE followed by INC; (S3) EZE followed by BA and PCSK9i; (S4) EZE followed by BA and INC; (S5) EZE followed by BA, INC, and then a PCSK9i.
RESULTS: The study cohort comprised 34,967 patients, with 29% high-risk and 71% very high-risk. Mean ± standard deviation baseline LDL-C was 109±40 mg/dL. All algorithms including a PCSK9i achieved LDL-C control in 98% of patients, whereas those without it achieved it in 88%. The annual cost per treated patient was the highest in the algorithm S1 (€5,635), followed by S2 (€4,316; -23%), S3 (€3,955; -30%), S5 (€3,339; -41%), and S4 (€3,142; -44%). Introducing BA prior to injectable therapies resulted in significant cost reductions while achieving the same level of control as with algorithms that do not include BA.
CONCLUSIONS: In patients with high or very high cardiovascular risk not controlled with statins and EZE, early inclusion of BA in treatment algorithms can achieve a similar share of patients with controlled LDL-C levels as PSK9 therapy, while significantly reducing budget impact. Cost-based sequencing provides an efficient approach for healthcare systems.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
SA86
Topic
Economic Evaluation, Study Approaches
Topic Subcategory
Decision Modeling & Simulation
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)