Targeted Literature Review Informing Economic Model Structures in Atherosclerotic Cardiovascular Disease
Author(s)
Luiz Causin, MS1, Kirk Szafranski, MSc2, Maria Caiado, MASc1, Sandra Vigelis, MBiotech2, Juliette Neyra, PharmD3, Pamela Vo, MS, PharmD4.
1Novartis Pharmaceuticals UK Ltd, London, United Kingdom, 2EVERSANA, Burlington, ON, Canada, 3Novartis Pharmaceuticals Canada Inc, Montreal, QC, Canada, 4Vice President, HEOR, EVERSANA, Basel, Switzerland.
1Novartis Pharmaceuticals UK Ltd, London, United Kingdom, 2EVERSANA, Burlington, ON, Canada, 3Novartis Pharmaceuticals Canada Inc, Montreal, QC, Canada, 4Vice President, HEOR, EVERSANA, Basel, Switzerland.
OBJECTIVES: To conduct an economic targeted literature review (TLR) to identify and critically appraise published cost-effectiveness models (CEMs) in atherosclerotic cardiovascular disease (ASCVD) from health technology assessment (HTA) submissions and journal articles.
METHODS: A TLR was performed using MEDLINE, along with searching key HTA agency websites (National Institute for Health and Care Excellence [NICE], Canada’s Drug Agency [CDA-AMC], Pharmaceutical Benefits Advisory Committee [PBAC]), as well as the Institute for Clinical and Economic Review [ICER]), and the Center for the Evaluation of Value and Risk in Health (CEVR) Cost-Effectiveness Analysis (CEA) Registry. A hand search of review articles identified during the screening process was also performed. Key model details, assumptions, strengths, and limitations/criticisms were extracted.
RESULTS: A total of 56 records were included. Markov cohort models were the predominant model structure in both ASCVD HTA submissions (89%) and in journal articles (85%). A frequent criticism from HTA agencies was the use of surrogate outcomes, particularly low-density lipoprotein cholesterol, to predict treatment efficacy (i.e., cardiovascular event reduction). Journal articles reporting ASCVD CEMs linked to HTA submissions generally assessed more specific subpopulations and also demonstrated that different model structures have been developed for journal publication versus HTA submission. Whereas Markov cohort models are traditionally used for ASCVD, some HTA agencies’ comments suggested microsimulation models (3% of ASCVD HTA submissions) may be appropriate for accurately modelling complex disease histories.
CONCLUSIONS: Although the choice of model structure used in HTA submissions in ASCVD tends to follow the precedence of previous ASCVD submissions (i.e., Markov cohort), other types of model structures are also feasible and can be accepted by HTA agencies. In contrast, a greater diversity of model structures in ASCVD is present in published journal articles. Ultimately, the choice of model structure depends on the specific decision problem and limitations of the data source.
METHODS: A TLR was performed using MEDLINE, along with searching key HTA agency websites (National Institute for Health and Care Excellence [NICE], Canada’s Drug Agency [CDA-AMC], Pharmaceutical Benefits Advisory Committee [PBAC]), as well as the Institute for Clinical and Economic Review [ICER]), and the Center for the Evaluation of Value and Risk in Health (CEVR) Cost-Effectiveness Analysis (CEA) Registry. A hand search of review articles identified during the screening process was also performed. Key model details, assumptions, strengths, and limitations/criticisms were extracted.
RESULTS: A total of 56 records were included. Markov cohort models were the predominant model structure in both ASCVD HTA submissions (89%) and in journal articles (85%). A frequent criticism from HTA agencies was the use of surrogate outcomes, particularly low-density lipoprotein cholesterol, to predict treatment efficacy (i.e., cardiovascular event reduction). Journal articles reporting ASCVD CEMs linked to HTA submissions generally assessed more specific subpopulations and also demonstrated that different model structures have been developed for journal publication versus HTA submission. Whereas Markov cohort models are traditionally used for ASCVD, some HTA agencies’ comments suggested microsimulation models (3% of ASCVD HTA submissions) may be appropriate for accurately modelling complex disease histories.
CONCLUSIONS: Although the choice of model structure used in HTA submissions in ASCVD tends to follow the precedence of previous ASCVD submissions (i.e., Markov cohort), other types of model structures are also feasible and can be accepted by HTA agencies. In contrast, a greater diversity of model structures in ASCVD is present in published journal articles. Ultimately, the choice of model structure depends on the specific decision problem and limitations of the data source.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE682
Topic
Economic Evaluation, Health Technology Assessment, Study Approaches
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas