Lindgren P1, Hagström E2, van Hout B3, Villa G4, Pemberton-Ross P4, Arellano J5, Sibartie M4, Fonarow GC6
1Karolinska Institutet, Stockholm, Sweden, 2Uppsala University, Uppsala, Sweden, 3University of Sheffield, Sheffield, UK, 4Amgen (Europe) GmbH, Rotkreuz, Switzerland, 5Amgen Inc., Thousand Oaks, CA, USA, 6University of California Los Angeles, Los Angeles, CA, USA

OBJECTIVES : Evolocumab, a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, is indicated for the reduction of cardiovascular (CV) risk by lowering LDL-C, an important modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD). We assessed the cost-effectiveness of evolocumab added to standard of care (SoC), maximally tolerated lipid-lowering treatment, in ASCVD patients with varying risk profiles in Sweden. METHODS : A previously published Markov model was updated and adapted to the Swedish context. Patient characteristics and baseline CV event (myocardial infarction, ischemic stroke, CV death) rates were taken from published sources using data from Swedish national registries. Observed rates of 6.29 and 7.33 major CV events per 100 patient-years, adjusted by LDL-C, were used, respectively, for ASCVD patients and ASCVD patients with diabetes mellitus (DM), to illustrate a higher risk ASCVD subpopulation. Baseline LDL-C levels were simulated for ≥100 and ≥70 mg/dL. The model used an evolocumab LDL-C reduction of 59%, as observed in the FOURIER trial, and the relationship between LDL-C lowering and CV events reduction from the Cholesterol Treatment Trialists’ Collaboration (CTTC) 2010 meta-analysis. An annual evolocumab list price (before discount) of SEK48,759 [€4,681] (SEK1 = €0.096) was considered. Costs and health outcomes were evaluated over a lifetime horizon. RESULTS : In ASCVD patients, the incremental cost-effectiveness ratio (ICER) was SEK493,815 [€47,406] if LDL-C ≥100 mg/dL and SEK729,792 [€70,060] if LDL-C ≥70 mg/dL. In ASCVD patients with DM, the ICER was SEK453,342 [€43,521] if LDL-C ≥100 mg/dL and SEK663,863 [€63,731] if LDL-C ≥70 mg/L. CONCLUSIONS : In ASCVD patients with LDL-C ≥100 mg/dL, the addition of evolocumab to SoC results in an ICER below generally accepted willingness-to-pay thresholds by Swedish authorities, such as the Dental and Pharmaceutical Benefits Agency (TLV). Evolocumab might also offer high value in ASCVD patients with additional risk factors and lower LDL-C levels, aligned with recently updated clinical guidelines.

Conference/Value in Health Info

2019-11, ISPOR Europe 2019, Copenhagen, Denmark




Economic Evaluation, Methodological & Statistical Research

Topic Subcategory

Modeling and simulation


Cardiovascular Disorders

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