OBJECTIVES: Cardiovascular disease (CVD) remains a leading morbidity with reducing LDL cholesterol (LDL-C) a key prevention target. While statins are the established first-line treatment, newer treatments further reduce LDL-C and CVD risk. We assess at what cost such treatments would be good value-for-money for primary CVD prevention in UK.

METHODS: A recently published CVD micro-simulation model projected incident cardiovascular events, mortality, quality of life, and healthcare costs (2021 UK£) using individual sociodemographic and clinical characteristics. We assessed lifetime health outcomes and healthcare costs with use of high intensity statin therapy (atorvastatin 80mg/day) and the impact of adding a treatment achieving further 50% LDL-C reduction (e.g. inclisiran/PCSK9 inhibitor) across UK Biobank participants (440,000 40-70 years old participants without CVD at recruitment). We report the annual treatment cost at which this treatment would be considered cost-effective at thresholds of £20,000 per quality adjusted life year (QALY) gained, in categories by age, sex, 10-year CVD risk (<5%; 5-10%, 10-15%, 15-20%, ≥20%) and untreated LDL-C (<3.4, 3.4-4.1, ≥4.1mmol/L).

RESULTS: Higher CVD risk, higher untreated LDL-C level and male sex were associated with larger CVD risks and larger health gains from LDL-C lowering treatments. Acceptable treatment cost across the categories was strongly associated with health benefit achieved. At £20,000/QALY, the maximum annual cost for the further LDL-C lowering treatment to be cost-effective for people with untreated LDL-C≥4.1mmol/L ranged from £134 for CVD risk≥20% to £28 for CVD risk <5%. For the new treatment to be cost-effective for people with untreated LDL-C of 3.4-4.1mmol/L, the annual cost had to be ≤£69 for CVD risk≥20%, and ≤£12 for CVD risk<5%. Wider treatment adoption will depend on treatment cost and decision-makers’ considerations for efficiency in patient categories.

CONCLUSIONS: Value-for-money at given treatment cost varies across patient categories with implications for treatment adoption.