OBJECTIVES : Atherosclerotic cardiovascular disease (ASCVD) represents a major health challenge for the Saudi Arabian population, in which the prevalence of cardiovascular (CV) risk factors including elevated low-density lipoprotein cholesterol (LDL-C) is increasing. The proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor evolocumab (Repatha^®) has been demonstrated to reduce the risk of recurrent CV events in patients whose LDL-C levels are not controlled despite statin-based lipid-lowering therapy. Those most likely to experience CV events include patients with clinically evident ASCVD and Familial hypercholesterolemia. This study is conducted to evaluate the cost-effectiveness of evolocumab in the Kingdom of Saudi Arabia and to detail the underlying economic model.

METHODS : The Markov cohort state transition model incorporates efficacy estimates from evolocumab’s outcomes study, FOURIER, and observational research data on baseline CV event rates in actual clinical practice. All analyses are conducted from a public healthcare perspective in the KSA.

RESULTS : In patients with clinically evident ASCVD and baseline LDL-C ≥70 mg/dL (1.8 mmol/L) or ≥100 mg/dL (2.6 mmol/L), adding evolocumab to maximally tolerated statin (with or without ezetimibe) is associated, respectively, with an incremental cost per quality-adjusted life year (QALY) gained of 109,274 SAR and 75,163 SAR over a lifetime time horizon. In heterozygous familial hypercholesterolemia (HeFH) patients with baseline LDL-C ≥100 mg/dL, adding evolocumab to background LLT is associated with an incremental cost per QALY gained of 22,391 SAR over a patient’s lifetime compared with background LLT. These findings are robust to changes in the model input parameters and fall below the conventionally applied threshold of up to three times the gross domestic product (GDP) per capita (about 265,000 SAR).

CONCLUSIONS : In clinically evident ASCVD or FH patients who are unable to control LDL-C levels with conventional LLTs, adding evolocumab reduces unnecessary CV events, partially lessening the substantial impact of ASCVD on the hospital system, patients, and society.