BACKGROUND: Icosapent ethyl is a new active substance indicated to reduce the risk of cardiovascular (CV) events in adult statin-treated patients at high cardiovascular risk with elevated triglycerides (≥150 mg/dL), and 1) established cardiovascular disease (eCVD), or 2) diabetes, and at least one other cardiovascular risk factor.

OBJECTIVES: This study estimated the cost-effectiveness of icosapent ethyl plus statins compared to statin-treatment alone from a societal perspective in The Netherlands in 2021.

METHODS: A cost-utility model was used with health states defined by the occurrence of a first or subsequent fatal or non-fatal CV event. Health state occupancy was estimated using a partitioned-state survival model of time to CV events. Population characteristics and clinical inputs were derived from the pivotal trial (REDUCE-IT) of icosapent ethyl. Utility values and costs were linked to each health state. Drug acquisition, disease management, adverse event (AE) costs and AE disutilities were also included. Outcomes were calculated over a lifetime horizon for the overall population and the subgroup of eCVD patients. Costs were discounted at 4%, effects at 1.5%.

RESULTS: The incremental discounted results of icosapent ethyl versus statins alone in the overall population were 0.438 life years, 0.521 QALYs, and €9,595 costs. The resulting incremental cost-effectiveness ratio (ICER) of €18,415/QALY was in line with the relevant reference willingness-to-pay threshold (WTP) of €20,000/QALY, with a probability of 60.1% of being cost-effective in the probabilistic analysis. The incremental results for the eCVD sub-population were 0.542 life years, 0.633 QALYs and €9,216 costs, yielding an ICER of €14,553/QALY. Icosapent ethyl had a probability of 99.1% to be cost-effective at the for this sub-population relevant reference WTP of €50,000.

CONCLUSIONS: Treatment with icosapent ethyl on top of statins is cost-effective vs statins alone. Cost-effectiveness increases in an eCVD sub-population.