OBJECTIVES: Severe HTG is not only associated with residual risk of cardiovascular disease (CVD) for patients with reduced low-density lipoprotein cholesterol, but also has been shown to be an independent risk factor for the severity and recurrence of hypertriglyceridemia-induced severe acute pancreatitis (HTG-SAP). IPE showed a strong triglyceride-lowering effect compared to placebo in the Phase III randomized clinical trial (RCT) in China. Therefore, this study aimed to compare the cost-effectiveness of IPE to placebo for triglyceride reduction and long-term clinical benefit in patients with severe HTG from the perspective of Chinese health care system.

METHODS: A time-dependent Markov transition model over a lifetime horizon was developed, including 12 health states of severe HTG, HTG, first event of ischemic stroke (IS), post IS, IS recurrence, first event of myocardial infarction (MI), post MI, MI recurrence, first event of HTG-SAP, post HTG-SAP, HTG-SAP recurrence, and death. Probabilities between the health states of severe HTG and HTG were derived from the efficacy data in phase III RCT in China (CTR20170362). Other transition probabilities, costs and utilities were obtained from published literature. Incremental cost-effectiveness ratios (ICERs) were expressed in CNY (¥) per QALY gained, with all costs and utilities discounted at 5% annually. Both one-way and probabilistic sensitivity analyses were undertaken.

RESULTS: Compared with placebo, IPE resulted in a total incremental cost per patient of ¥149,980, but provided an additional 0.75 QALYs. The ICER was ¥198,939/QALY gained, indicating that IPE is cost-effective at a threshold of ¥257,094 per QALY in 2022 (three times of GDP in China). In addition, one-way and probabilistic sensitivity analyses showed that the results were robust, and IPE is cost-effective in 73% of 1000 simulations.

CONCLUSIONS: IPE represents cost-effectiveness versus placebo for triglyceride-lowering and thus reducing the risk of CVD and HTG-SAP in patients with severe HTG in China.