Background:
The Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial (REDUCE-IT) showed that patients with elevated baseline triglycerides (TG) and well-controlled LDL-C levels on statins had a 30% lower risk of total cardiovascular events with 4g of icosapent ethyl (IPE) daily compared to standard care (SC) during a median 4.9 year follow-up. The purpose of this study was to conduct subgroup analyses of lifetime cost-effectiveness (CE) of IPE compared to SC alone.
Methods:
Applying treatment effects from REDUCE-IT, health care costs from the National Inpatient Sample (NIS), and net costs for IPE of $4.16 a day, we conducted a combination CE analysis utilizing patient level in-trial cost and clinical outcomes with long-term costs, events, and life expectancy derived from Markov simulation models. The model projected lifetime health care costs, cardiovascular events, survival, and quality-adjusted life-years (QALYs) for IPE vs. SC from a payer perspective among overall trial-eligible patients and in key subgroups.
Results:
The lifetime mean costs for IPE and SC were $196,080 and $197,064, and the lifetime QALYs for IPE and SC were 10.61 and 10.35, respectively (Table 1). IPE was a dominant strategy over the lifetime in 69.7% of simulations with the probability of CE at the nominal $50,000, $100,000, and $150,000 thresholds being replicated in 87.9%, 98.6%, and 99.9% of simulations, respectively. In the subgroups of age <65 years, male sex, subjects with or without diabetes, secondary prevention cohort, TG levels ≥200 or ≥150 mg/dL, and baseline LDL≥70 mg/dL, IPE was a dominant strategy over the lifetime. In women or the primary prevention cohort, IPE was cost-effective with an ICER of $16,660 or $21,890 per QALY gained, respectively.
Conclusions:
In all subgroups, IPE at a cost of $4.16/day was shown to be cost-effective at a willingness-to-pay threshold of $50,000 per QALY and was a dominant treatment strategy in most subgroups.
Systematic Litertaure Review Of Direct Health Care Costs For Cardiovascular Events Among European Patients With Dyslipidemia Or High Cardiovascular Risk
