EVALUATION OF COST-EFFECTIVENESS MODELS FOR LIPID-LOWERING THERAPIES IN ATHEROSCLEROTIC CARDIOVASCULAR DISEASE PREVENTION: A SYSTEMATIC LITERATURE REVIEW
Author(s)
Ikksheta Sharma, MSc1, Adam Johns, MSc2, Rod S. Taylor, PhD3, Ajay Malvi, MSc1, Rizwan Ameen, MPharm1, Amatullah S. Qadeer, Masters1, Oliver Darlington, MSc4, Tom Ward, MSc4, Alex van Doornewaard, MSc4, Amy Zhou, PhD5, Onivefu Odelade, MSc6, Eskinder Tafesse, PhD7, Juan Jose Garcia Sanchez, BSc, MSc, PharmD8, Andrew Briggs, DPhil9.
1OPEN Health, Bangalore, India, 2Global Market Access & Pricing, HTA and Modelling Science, BioPharmaceuticals Medical, AstraZeneca, Barcelona, Spain, 3Robertson Centre for Biostatistics and General Practice & Primary Care, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom, 4Horizon Health Economics, Cardiff, United Kingdom, 5Global Market Access & Pricing, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom, 6Global Medical Affairs, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom, 7Global Market Access & Pricing, Health Economics and Payer Evidence, BioPharmaceuticals Medical, AstraZeneca, Wilmington, PA, USA, 8Global Market Access & Pricing, Health Economics and Payer Evidence, BioPharmaceuticals Medical, AstraZeneca, Barcelona, Spain, 9London School of Hygiene & Tropical Medicine, London, United Kingdom.
1OPEN Health, Bangalore, India, 2Global Market Access & Pricing, HTA and Modelling Science, BioPharmaceuticals Medical, AstraZeneca, Barcelona, Spain, 3Robertson Centre for Biostatistics and General Practice & Primary Care, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom, 4Horizon Health Economics, Cardiff, United Kingdom, 5Global Market Access & Pricing, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom, 6Global Medical Affairs, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom, 7Global Market Access & Pricing, Health Economics and Payer Evidence, BioPharmaceuticals Medical, AstraZeneca, Wilmington, PA, USA, 8Global Market Access & Pricing, Health Economics and Payer Evidence, BioPharmaceuticals Medical, AstraZeneca, Barcelona, Spain, 9London School of Hygiene & Tropical Medicine, London, United Kingdom.
OBJECTIVES: Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death, imposing a substantial health and socioeconomic burden. Despite effective lipid-lowering therapies, notable gaps exist between guideline-recommended targets and achievement. Novel interventions under investigation, including oral PCSK9 inhibitors, and fixed-dose combinations may simplify management and improve outcomes. This systematic literature review (SLR) aimed to characterise modelling approaches in ASCVD to guide future health economic evaluations.
METHODS: Electronic databases (EMBASE, MEDLINE, EconLit) were searched from 1/1/2015-8/10/2025, supplemented by grey literature (e.g. health technology assessment [HTA] websites). Screening and extraction were completed by two reviewers.
RESULTS: The SLR identified 36 publications (articles: n=26; HTA reports: n=9; conference abstracts: n=1); six additional HTA reports were further considered. These included 29 cost-effectiveness models (all Markov state-transition), with 26 reporting an annual cycle length (5-year: n=1; 1-month: n=1; not reported: n=1). All models reporting health states included cardiovascular (CV) events. Stroke was included in 23/29, myocardial infarction (MI) in 15/29 and a composite acute coronary syndrome state (e.g. unstable angina [UA] or MI) in 11/29. Other events included UA (n=5), heart failure (n=3), transient ischaemic attack (n=3) and stable angina (n=2). Overall, 23 studies included post-event states, with seven including time-stratified post-event tunnel states. Death was often stratified by CV cause (n=24). Studies generally used surrogate endpoints to estimate CV event incidence, most commonly low-density lipoprotein cholesterol (LDL-C; n=22/29). Modelled LDL-C reductions lowered CV event risk, often using statin risk-reduction estimates from Cholesterol Treatment Trialists' Collaboration meta-analyses (n=19). Event rates were generally from local real-world evidence and published risk equations; alignment of risks to target populations was a common challenge, requiring adjustments using external data.
CONCLUSIONS: Despite strong precedents in cost-effectiveness modelling for ASCVD, heterogeneity remains across the evidence base, notably with respect to events modelled and post-event health states. This indicates scope for refinement in future models.
METHODS: Electronic databases (EMBASE, MEDLINE, EconLit) were searched from 1/1/2015-8/10/2025, supplemented by grey literature (e.g. health technology assessment [HTA] websites). Screening and extraction were completed by two reviewers.
RESULTS: The SLR identified 36 publications (articles: n=26; HTA reports: n=9; conference abstracts: n=1); six additional HTA reports were further considered. These included 29 cost-effectiveness models (all Markov state-transition), with 26 reporting an annual cycle length (5-year: n=1; 1-month: n=1; not reported: n=1). All models reporting health states included cardiovascular (CV) events. Stroke was included in 23/29, myocardial infarction (MI) in 15/29 and a composite acute coronary syndrome state (e.g. unstable angina [UA] or MI) in 11/29. Other events included UA (n=5), heart failure (n=3), transient ischaemic attack (n=3) and stable angina (n=2). Overall, 23 studies included post-event states, with seven including time-stratified post-event tunnel states. Death was often stratified by CV cause (n=24). Studies generally used surrogate endpoints to estimate CV event incidence, most commonly low-density lipoprotein cholesterol (LDL-C; n=22/29). Modelled LDL-C reductions lowered CV event risk, often using statin risk-reduction estimates from Cholesterol Treatment Trialists' Collaboration meta-analyses (n=19). Event rates were generally from local real-world evidence and published risk equations; alignment of risks to target populations was a common challenge, requiring adjustments using external data.
CONCLUSIONS: Despite strong precedents in cost-effectiveness modelling for ASCVD, heterogeneity remains across the evidence base, notably with respect to events modelled and post-event health states. This indicates scope for refinement in future models.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE7
Topic
Economic Evaluation, Methodological & Statistical Research
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)