OBJECTIVES

: Non-statin therapies (NSTs) have shown to provide additional benefits for cardiovascular risk reduction among patients with type 2 diabetes mellitus (T2DM), but their economic merits have not been fully confirmed. The objective of the systematic review was to evaluate the cost-effectiveness of NSTs for the primary and secondary prevention of cardiovascular disease (CVD) in patients with T2DM.

METHODS

: A literature search was systematically performed using MeSH terms from January 1990 to January 2021 in ten databases (e.g. MEDLINE, PubMed, EMBASE, and EconLit). Two reviewers independently screened the included studies that evaluated the cost-effectiveness of NSTs versus any comparator. Quality of Health Economic Studies (QHES) checklist was used for quality assessment. Cost outputs were adapted to 2018 USD to facilitate comparisons between studies.

RESULTS

: The search identified 13 studies, where ezetimibe, Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) inhibitors, fenofibrate, polypill, nicotinic acid, and extended-release niacin/laropiprant (ER- ERN/LRPT) were compared to standard care. Six out of eight included studies considered ezetimibe plus statin to be a cost-effective therapy for patients with T2DM and with or without CVD, three out of four included studies suggested that PCSK9 inhibitors are not cost-effective at the current pricing arrangements. Fenofibrate is a cost-effective option either as monotherapy or combined with statin, and nicotinic acid, polypill, and ER- ERN/LRPT were also cost-effective. The overall QHES quality of the majority of economic evaluations had good quality of reporting. The main cost-effectiveness drivers were the cost of drug and the baseline risk of CVD events. The incremental cost-effectiveness ratios were consistent in the majority of studies after adaptation to 2018 USD values.

CONCLUSIONS

: While majority of NSTs may be cost-effective options compared to standard care for primary and secondary prevention of CVD in patients with T2DM, PCSK9 inhibitors are not at the current pricing arrangements.