UPDATED COST-EFFECTIVENESS ANALYSIS OF EVOLOCUMAB IN PATIENTS WITH CLINICALLY EVIDENT ATHEROSCLEROTIC CARDIOVASCULAR DISEASE
Author(s)
Gregg C. Fonarow, MD1, Cameron Christian Cook, BA, MA, MS, PhD2, Eduard Sidelnikov, MPH, MSc, PhD, MD3, Guillermo Villa, MSc, PhD4.
1University of California, Los Angeles, CA, USA, 2AMGEN, Durham, NC, USA, 3HEOR Director, AMGEN (Europe) GmbH, Rotkreuz, Switzerland, 4Global Health Economics, Amgen, Rotkreuz, Switzerland.
1University of California, Los Angeles, CA, USA, 2AMGEN, Durham, NC, USA, 3HEOR Director, AMGEN (Europe) GmbH, Rotkreuz, Switzerland, 4Global Health Economics, Amgen, Rotkreuz, Switzerland.
OBJECTIVES: Following availability of evolocumab at a direct-to-patient price of $3,107/year, we evaluated the cost-effectiveness of evolocumab plus standard therapy versus standard therapy alone in adults with clinically evident atherosclerotic cardiovascular disease (ASCVD) and low-density lipoprotein cholesterol (LDL-C) ≥ 70 mg/dL.
METHODS: A previously published Markov cohort state-transition model (Fonarow et al. 2017) was used to simulate ASCVD patients over a lifetime horizon. Health states included clinically evident ASCVD, myocardial infarction (MI), ischemic stroke (IS), post-MI, post-IS, cardiovascular (CV) death, and non-CV death. Revascularizations (RV) were modeled as a procedure. Baseline characteristics and event rates from a US representative real-world cohort with LDL-C ≥ 70 mg/dL used in Fonarow et al. 2017 were applied. The base case applied a payer perspective and CV risk-reduction estimates from FOURIER/FOURIER-OLE trials. Scenario 1 used payer perspective with Cholesterol Treatment Trialists’ (CTT) Collaboration 2010 meta-analysis risk-reduction estimates. Scenarios 2 and 3 evaluated the trial-based and CTT-based risk-reduction assumptions, respectively, from a societal perspective. Outcomes included major adverse cardiovascular events (MACE: MI, IS, or CV death), RV procedures, costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER).
RESULTS: In the base case, evolocumab plus standard therapy reduced MACE by 0.30 and RV procedures by 0.09 per patient, and increased costs by $20,055, LYs by 0.82, and QALYs by 0.63, yielding an ICER of $31,837/QALY. ICERs were $14,924/QALY in Scenario 1, $16,341/QALY in Scenario 2, and cost-saving (more effective with lower total costs versus standard therapy alone) in Scenario 3. Deterministic sensitivity analysis showed results were robust.
CONCLUSIONS: Evolocumab plus standard therapy improved outcomes and was cost-effective in patients with clinically evident ASCVD, with ICERs substantially below the American Heart Association/American College of Cardiology-recommended $120,000/QALY willingness-to-pay threshold across all analyses. It was cost-saving in the scenario under a societal perspective and CTT-based risk-reduction estimates.
METHODS: A previously published Markov cohort state-transition model (Fonarow et al. 2017) was used to simulate ASCVD patients over a lifetime horizon. Health states included clinically evident ASCVD, myocardial infarction (MI), ischemic stroke (IS), post-MI, post-IS, cardiovascular (CV) death, and non-CV death. Revascularizations (RV) were modeled as a procedure. Baseline characteristics and event rates from a US representative real-world cohort with LDL-C ≥ 70 mg/dL used in Fonarow et al. 2017 were applied. The base case applied a payer perspective and CV risk-reduction estimates from FOURIER/FOURIER-OLE trials. Scenario 1 used payer perspective with Cholesterol Treatment Trialists’ (CTT) Collaboration 2010 meta-analysis risk-reduction estimates. Scenarios 2 and 3 evaluated the trial-based and CTT-based risk-reduction assumptions, respectively, from a societal perspective. Outcomes included major adverse cardiovascular events (MACE: MI, IS, or CV death), RV procedures, costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER).
RESULTS: In the base case, evolocumab plus standard therapy reduced MACE by 0.30 and RV procedures by 0.09 per patient, and increased costs by $20,055, LYs by 0.82, and QALYs by 0.63, yielding an ICER of $31,837/QALY. ICERs were $14,924/QALY in Scenario 1, $16,341/QALY in Scenario 2, and cost-saving (more effective with lower total costs versus standard therapy alone) in Scenario 3. Deterministic sensitivity analysis showed results were robust.
CONCLUSIONS: Evolocumab plus standard therapy improved outcomes and was cost-effective in patients with clinically evident ASCVD, with ICERs substantially below the American Heart Association/American College of Cardiology-recommended $120,000/QALY willingness-to-pay threshold across all analyses. It was cost-saving in the scenario under a societal perspective and CTT-based risk-reduction estimates.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE5
Topic
Economic Evaluation, Health Technology Assessment
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas