OBJECTIVES: To estimate the incremental cost-effectiveness ratio (ICER) of evolocumab as add-on treatment for patients with atherosclerotic cardiovascular disease (ASCVD) who cannot adequately control their cholesterol despite optimized lipid-lowering therapy (LLT). The base case considers patients with prior myocardial infarction (MI) and baseline LDL-C ≥ 1.8mmol/L; evolocumab was considered add-on treatment to optimized LLT defined as moderate- to high-intensity statin with or without ezetimibe.

METHODS: A cost-utility analysis from the societal perspective in Quebec, Canada was conducted using a Markov model. Costs and health outcomes were evaluated over a lifetime horizon and were discounted at 1.5% annually. The base case used a baseline CV event rate from statin-treated ASCVD patients in a real-world setting, LDL-C reduction efficacy from the FOURIER trial, and the relationship between LDL-C lowering and CV events from meta-analyses conducted by the Cholesterol Treatment Trialists’ Collaboration. Medical costs (2018-2019 CAD$), are from Canadian data sources, and ASCVD health state utilities are from a time trade off study in the UK.

RESULTS: In ASCVD patients with prior MI and baseline LDL-C ≥ 1.8mmol/L, adding evolocumab to optimized LLT compared with optimized LLT led to an incremental cost per QALY gained of CAD$66,783. When all ASCVD patients with LDL-C ≥ 1.8mmol/L were modelled using FOURIER trial inputs, the ICER was CAD$108,836 per QALY.

CONCLUSIONS: In ASCVD patients with prior MI and in additional scenario analyses for all ASCVD patients with LDL-C ≥ 1.8mmol/L, adding evolocumab to optimized LLT may be considered cost-effective in Canada.