Real-World–Based Cost-Effectiveness of Lipid-Lowering Therapies for ASCVD Patients With High CV Risk in Taiwan
Author(s)
Elise Chia Hui Tan, PhD.
Assistant Professor, China Medical University, Taiwan, Taichung, Taiwan.
Assistant Professor, China Medical University, Taiwan, Taichung, Taiwan.
OBJECTIVES: Many statin-treated ASCVD patients still have high LDL-C levels, indicating statin intolerance and uncontrolled hypercholesterolemia. PCSK9 inhibitors reduce cardiovascular events by lowering LDL-C and delaying atherosclerosis. Previously published cost-effectiveness studies of PCSK9-I have yielded mixed results and often used inputs from clinical trial. Innovative cost-effectiveness models based on real-world data are needed to reflect clinical practice outcomes better. The study developed a novel real-world data based cost-effectiveness model to compare PSCK9 inhibitor treatment for ASCVD patients with LDL-C level ≥100 mg/dL.
METHODS: The lifetime Markov model was utilized. The baseline age, gender, diabetes history, LDL-C level, and CV event rate from the National Health Insurance Research Database were used to build a simulated cohort. High-intensity statin efficacy was evaluated using NHIRD patient-level data as the first arm in the mode. The relative LDL-C reduction was via network meta-analysis. Pooled clinical studies provided utility. From NHIRD, event-based and follow-up direct medical costs of CV events were computed. Prices were 2024, and discounts were 3% for cost and effectiveness.
RESULTS: Compared to high-intensity statin treatment for ASCVD patients with LDL-C levels ≥100 mg/dL, high-intensity statin/ezetimibe (hS/Eze) was dominant. The incremental cost-effectiveness ratio (ICER) per QALY gained was €31,918.75 for hS/PCSK9-I and €115,597.76 for hS/Eze/PCSK9-I. Compared to hS/Eze, the ICER per QALY gained was €44,399 for hS/PCSK9-I and €229,880 for hS/Eze/PCSK9-I. Using €28,798 (1 GDP per capita in 2023 in Taiwan) as the willingness-to-pay threshold, the probability of being cost-effective was 38.3% for hS/Eze, 24.9% for hS/PCSK9-I, and 36.8% for hS/Eze/PCSK9-I. All results from the RWD-based model reported higher ICER values than those from the RCT-based model.
CONCLUSIONS: Combining ezetimibe, PSCK9-I, or triple treatment for ASCVD patients with LDL-C ≥100 mg/DL is cost-effective compared to high-intensity. RWD could be used while developing a CE model and demonstrate the value of combination therapy.
METHODS: The lifetime Markov model was utilized. The baseline age, gender, diabetes history, LDL-C level, and CV event rate from the National Health Insurance Research Database were used to build a simulated cohort. High-intensity statin efficacy was evaluated using NHIRD patient-level data as the first arm in the mode. The relative LDL-C reduction was via network meta-analysis. Pooled clinical studies provided utility. From NHIRD, event-based and follow-up direct medical costs of CV events were computed. Prices were 2024, and discounts were 3% for cost and effectiveness.
RESULTS: Compared to high-intensity statin treatment for ASCVD patients with LDL-C levels ≥100 mg/dL, high-intensity statin/ezetimibe (hS/Eze) was dominant. The incremental cost-effectiveness ratio (ICER) per QALY gained was €31,918.75 for hS/PCSK9-I and €115,597.76 for hS/Eze/PCSK9-I. Compared to hS/Eze, the ICER per QALY gained was €44,399 for hS/PCSK9-I and €229,880 for hS/Eze/PCSK9-I. Using €28,798 (1 GDP per capita in 2023 in Taiwan) as the willingness-to-pay threshold, the probability of being cost-effective was 38.3% for hS/Eze, 24.9% for hS/PCSK9-I, and 36.8% for hS/Eze/PCSK9-I. All results from the RWD-based model reported higher ICER values than those from the RCT-based model.
CONCLUSIONS: Combining ezetimibe, PSCK9-I, or triple treatment for ASCVD patients with LDL-C ≥100 mg/DL is cost-effective compared to high-intensity. RWD could be used while developing a CE model and demonstrate the value of combination therapy.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE640
Topic
Clinical Outcomes, Economic Evaluation, Real World Data & Information Systems
Topic Subcategory
Value of Information
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity)