OBJECTIVES: This systematic review aims to provide an overview of published cost-effectiveness models of treatments in secondary prevention of MACE with focus on the key model parameters and aspects of model design applied.

METHODS: A literature search was conducted for the period of 2008 to 2017 using Embase^®, MEDLINE^® and NHSEED. Source of data, model design, assumptions and health states included were extracted from included studies. Two reviewers independently conducted the screening, data abstraction, and the quality assessment with a third reviewer consulted in case of any discrepancies.

RESULTS: Seventy studies were included, seven of these evaluating the cost-effectiveness profile of PCSK9 inhibitors. The studies covered multiple geographies, including US (24), Europe (25), Australia (2) and Asia (6). Majority of studies (53) were conducted from the payers perspective. Markov models were used in 29 studies (cohort approach: 27; patient-level simulation: 2) and hybrid models (combining Markov and decision-trees) in 23. MI, stroke, death were the most commonly reported health states, modelled generally as time to first event. Subsequent events (as a combined health state) were considered in five studies. Revascularisation was modelled as a health state in four studies and considered as an event in 16 studies. The majority of the models (50) employed a lifetime time horizon (≥30 years). Treatment effect (relative-risk/hazard-ratio) were estimated from composite MACE in four studies, while other studies either modelled individual CV events or this information was unclear. Treatment discontinuation was modelled in seven studies, considering the treatment discontinuation rates observed during the clinical trials.

CONCLUSIONS: A range of modelling approaches have been used to assess the cost-effectiveness of secondary prevention treatments. The Markov cohort approach was most widely used for the decision problem stated in most cases. Consistency on health states was also observed as most models incorporated MI, stroke and death with others occasionally added.