scholarly journals Cost-Effectiveness of Lipid-Lowering Therapies for Cardiovascular Prevention in Germany

2022 ◽  
Author(s):  
Daniel Tobias Michaeli ◽  
Julia Caroline Michaeli ◽  
Tobias Boch ◽  
Thomas Michaeli
Keyword(s):  
Cost Effectiveness ◽  
Secondary Prevention ◽  
Cardiovascular Events ◽  
Transition Probabilities ◽  
Cardiovascular Prevention ◽  
Lipid Lowering ◽  
Major Adverse Cardiovascular Events ◽  
Icosapent Ethyl ◽  
Use Of Resources ◽  
Statin Monotherapy

Abstract Purpose Novel pharmaceutical treatments reducing cardiovascular events in dyslipidaemia patients must demonstrate clinical efficacy and cost-effectiveness to promote long-term adoption by patients, physicians, and insurers. Objective To assess the cost-effectiveness of statin monotherapy compared to additive lipid-lowering therapies for primary and secondary cardiovascular prevention from the perspective of Germany’s healthcare system. Methods Transition probabilities and hazard ratios were derived from cardiovascular outcome trials for statin combinations with icosapent ethyl (REDUCE-IT), evolocumab (FOURIER), alirocumab (ODYSSEY), ezetimibe (IMPROVE-IT), and fibrate (ACCORD). Costs and utilities were retrieved from previous literature. The incidence of major adverse cardiovascular events was simulated with a Markov cohort model. The main outcomes were the incremental cost-effectiveness ratios (ICER) per quality adjusted life year (QALY) gained. Results For primary prevention, the addition of icosapent ethyl to statin generated 0.81 QALY and €14,732 costs (ICER: 18,133), whereas fibrates yielded 0.63 QALY and € − 10,516 costs (ICER: − 16,632). For secondary prevention, the addition of ezetimibe to statin provided 0.61 QALY at savings of € − 5,796 (ICER: − 9,555) and icosapent ethyl yielded 0.99 QALY and €14,333 costs (ICER: 14,485). PCSK9 inhibitors offered 0.55 and 0.87 QALY at costs of €62,722 and €87,002 for evolocumab (ICER: 114,639) and alirocumab (ICER: 100,532), respectively. A 95% probability of cost-effectiveness was surpassed at €20,000 for icosapent ethyl (primary and secondary prevention), €119,000 for alirocumab, and €149,000 for evolocumab. Conclusions For primary cardiovascular prevention, a combination therapy of icosapent ethyl plus statin is a cost-effective use of resources compared to statin monotherapy. For secondary prevention, icosapent ethyl, ezetimibe, evolocumab, and alirocumab increase patient benefit at different economic costs.

Valutazioni economiche di atorvastatina in prevenzione secondaria: un aggiornamento

2011 ◽  
Vol 12 (2S) ◽  
pp. 41-52 ◽  
Author(s):  
Simona De Portu ◽  
Sabato Montella ◽  
Paolo Cortesi ◽  
Enrica Menditto ◽  
Simona Cammarota ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cardiovascular Diseases ◽  
Secondary Prevention ◽  
Cardiovascular Events ◽  
Cost Effective ◽  
Economic Benefits ◽  
Therapeutic Interventions ◽  
Lipid Lowering ◽  
Control Groups ◽  
Mortality And Morbidity

Introduction: cardiovascular diseases are the most common reason of mortality and morbidity in the world, despite therapeutic interventions have improved patients’ prognosis in the last decades. Aggressive lipid lowering treatment with atorvastatin has demonstrated to be effective in preventing the occurrence of new cardiovascular events requiring hospitalizations, in patients previously affected by coronary syndromes. However, the increasing costs of managing cardiovascular diseases impose a careful analysis of the economic benefits of these therapies. Objective: to assess the economic sustainability of using atorvastatin for the secondary prevention of cardiovascular events. Material and Methods: we derived clinical information from five randomized, multicenter trials (AVERT, IDEAL, MIRACL, PROVE-IT, TNT) evaluating efficacy and tolerability of high dosage treatment with atorvastatin over control groups in different patient populations and for different follow up periods. A costeffectiveness analysis in the perspective of the NHS has been performed, under the hypothesis of the imminent price reduction of atorvastatin, due to the loss of exclusivity. Results: in trials AVERT, MIRACL, PROVE IT, the treatment with atorvastatin has demonstrated to reduce both cardiovascular events and overall healthcare direct costs, compared to the respective control groups. In trials IDEAL and TNT, the therapy with atorvastatin has resulted to be cost effective, with incremental cost-effectiveness ratio respectively of € 6,310 for avoided event (vs simvastatin 10 mg) and € 9,058 for CV disease free patient (vs atorvastatin 10 mg). Discussion: the present study represents an update of previous cost-effectiveness analyses, which have previously evaluated the economic consequences of using atorvastatin for the secondary prevention of cardiovascular events. The present analysis has proved the economic benefits deriving from the usage of atorvastatin, which is a dominant alternative in the AVERT, MIRACL and PROVE-IT clinical settings, and a cost effective option in the IDEAL and TNT study populations.

scholarly journals PCV55 Cost-Effectiveness of Icosapent Ethyl (IPE) for the Reduction of the Risk of Ischemic Cardiovascular Events in Canada.

2020 ◽  
Vol 23 ◽  
pp. S496
Author(s):  
J. Lachaine ◽  
J.N. Charron ◽  
J.C. Gregoire ◽  
R.A. Hegele ◽  
L.A. Leiter
Keyword(s):  
Cost Effectiveness ◽  
Cardiovascular Events ◽  
Icosapent Ethyl

scholarly journals PCV84 REHOSPITALIZATION DUE TO SUBSEQUENT CARDIOVASCULAR EVENTS IN SECONDARY PREVENTION PATIENTS TREATED WITH LIPID LOWERING THERAPIES IN ITALY

2019 ◽  
Vol 22 ◽  
pp. S557
Author(s):  
P. Sciattella ◽  
A.P. Maggioni ◽  
M. Belfiore ◽  
F. Sorio Vilela ◽  
D.A. Kahangire ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Cardiovascular Events ◽  
Lipid Lowering

scholarly journals Predicting major adverse cardiovascular events for secondary prevention: protocol for a systematic review and meta-analysis of risk prediction models

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e034564
Author(s):  
Ralph K Akyea ◽  
Jo Leonardi-Bee ◽  
Folkert W Asselbergs ◽  
Riyaz S Patel ◽  
Paul Durrington ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Cardiovascular Events ◽  
Prediction Models ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Prognostic Models ◽  
Major Adverse Cardiovascular Events ◽  
Bibliographic Databases ◽  
Analysis Model

IntroductionCardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. With advances in early diagnosis and treatment of CVD and increasing life expectancy, more people are surviving initial CVD events. However, models for stratifying disease severity risk in patients with established CVD for effective secondary prevention strategies are inadequate. Multivariable prognostic models to stratify CVD risk may allow personalised treatment interventions. This review aims to systematically review the existing multivariable prognostic models for the recurrence of CVD or major adverse cardiovascular events in adults with established CVD diagnosis.Methods and analysisBibliographic databases (Ovid MEDLINE, EMBASE, PsycINFO and Web of Science) will be searched, from database inception to April 2020, using terms relating to the clinical area and prognosis. A hand search of the reference lists of included studies will also be done to identify additional published studies. No restrictions on language of publications will be applied. Eligible studies present multivariable models (derived or validated) of adults (aged 16 years and over) with an established diagnosis of CVD, reporting at least one of the components of the primary outcome of major adverse cardiovascular events (defined as either coronary heart disease, stroke, peripheral artery disease, heart failure or CVD-related mortality). Reviewing will be done by two reviewers independently using the pre-defined criteria. Data will be extracted for included full-text articles. Risk of bias will be assessed using the Prediction model study Risk Of Bias ASsessment Tool (PROBAST). Prognostic models will be summarised narratively. If a model is tested in multiple validation studies, the predictive performance will be summarised using a random-effects meta-analysis model to account for any between-study heterogeneity.Ethics and disseminationEthics approval is not required. The results of this study will be submitted to relevant conferences for presentation and a peer-reviewed journal for publication.PROSPERO registration numberCRD42019149111.

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