IDEAS home Printed from https://ideas.repec.org/a/spr/pharme/v38y2020i9d10.1007_s40273-020-00948-w.html
   My bibliography  Save this article

Inclisiran as Adjunct Lipid-Lowering Therapy for Patients with Cardiovascular Disease: A Cost-Effectiveness Analysis

Author

Listed:
  • Ning Kam

    (Monash University)

  • Kanila Perera

    (Monash University)

  • Ella Zomer

    (Monash University)

  • Danny Liew

    (Monash University)

  • Zanfina Ademi

    (Monash University)

Abstract

Background Inclisiran inhibits hepatic synthesis of proprotein convertase subtilisin-kexin type 9 (PCSK9). The comparison of inclisiran with statin versus statin alone in the ORION-10 trial demonstrated significant reductions in low-density lipoprotein cholesterol (LDL-C). Our study explored whether the use of inclisiran with statin versus statin alone for secondary prevention of cardiovascular events is cost effective from the Australian healthcare perspective, based on the price of currently available PCSK9 inhibitors. Methods A Markov model was developed based on the ORION-10 trial to model outcomes and costs incurred by patients over a lifetime analysis. The three health states were ‘alive with cardiovascular disease (CVD)’, ‘alive with recurrent CVD’, and ‘dead’. Cost and utilities were estimated from published sources. The cost of inclisiran was estimated from the annual cost of evolocumab, a PCSK9 inhibitor currently available in Australia (AU$6334, based on 2020 data). Outcomes of interest were incremental cost-effectiveness ratios (ICERs) in terms of cost per quality-adjusted life-year (QALY) and cost per year of life saved (YoLS). All costs, QALYs and YoLS were discounted at 5% per annum in line with Australian standards. Results Among 1000 subjects followed-up over a lifetime analysis, inclisiran with statin compared with statin alone prevented 235 non-fatal myocardial infarctions (NFMIs; 151 NFMI and 84 repeat NFMI cases) and 114 coronary revascularisation cases, and increased years of life by 0.549 (discounted) and QALYs by 0.468 (discounted). At an annual price of AU$6334, the net marginal cost was AU$58,965 per person. The above values equated to ICERs of AU$107,402 per YoLS and AU$125,732 per QALY gained. Assuming a willingness-to-pay threshold of AU$50,000, inclisiran would have to be priced 60% lower than other available PCSK9 inhibitors to be considered cost effective. Conclusions As an adjunct therapy to statin treatment in those who have persistently elevated LDL-C despite optimal statin therapy, inclisiran is effective in reducing cardiovascular events in patients with atherosclerotic CVD. Inclisiran is not cost effective from the Australian healthcare perspective, assuming acquisition costs of current PCSK9 inhibitors. The cost of inclisiran would have to be 60% lower than that of evolocumab.

Suggested Citation

  • Ning Kam & Kanila Perera & Ella Zomer & Danny Liew & Zanfina Ademi, 2020. "Inclisiran as Adjunct Lipid-Lowering Therapy for Patients with Cardiovascular Disease: A Cost-Effectiveness Analysis," PharmacoEconomics, Springer, vol. 38(9), pages 1007-1020, September.
  • Handle: RePEc:spr:pharme:v:38:y:2020:i:9:d:10.1007_s40273-020-00948-w
    DOI: 10.1007/s40273-020-00948-w
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s40273-020-00948-w
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.

    File URL: https://libkey.io/10.1007/s40273-020-00948-w?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629, Decembrie.
    Full references (including those not matched with items on IDEAS)

    Citations

    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Rita Faria’s journal round-up for 14th September 2020
      by Rita Faria in The Academic Health Economists' Blog on 2020-09-14 11:00:07

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Chiranjeev Sanyal & Don Husereau, 2020. "Systematic Review of Economic Evaluations of Services Provided by Community Pharmacists," Applied Health Economics and Health Policy, Springer, vol. 18(3), pages 375-392, June.
    2. Arantzazu Arrospide & Oliver Ibarrondo & Iván Castilla & Igor Larrañaga & Javier Mar, 2022. "Development and Validation of a Discrete Event Simulation Model to Evaluate the Cardiovascular Impact of Population Policies for Obesity," Medical Decision Making, , vol. 42(2), pages 241-254, February.
    3. Mark Oppe & Daniela Ortín-Sulbarán & Carlos Vila Silván & Anabel Estévez-Carrillo & Juan M. Ramos-Goñi, 2021. "Cost-effectiveness of adding Sativex® spray to spasticity care in Belgium: using bootstrapping instead of Monte Carlo simulation for probabilistic sensitivity analyses," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(5), pages 711-721, July.
    4. Kaitlyn Hastings & Clara Marquina & Jedidiah Morton & Dina Abushanab & Danielle Berkovic & Stella Talic & Ella Zomer & Danny Liew & Zanfina Ademi, 2022. "Projected New-Onset Cardiovascular Disease by Socioeconomic Group in Australia," PharmacoEconomics, Springer, vol. 40(4), pages 449-460, April.
    5. Andrea Marcellusi & Raffaella Viti & Loreta A. Kondili & Stefano Rosato & Stefano Vella & Francesco Saverio Mennini, 2019. "Economic Consequences of Investing in Anti-HCV Antiviral Treatment from the Italian NHS Perspective: A Real-World-Based Analysis of PITER Data," PharmacoEconomics, Springer, vol. 37(2), pages 255-266, February.
    6. Risha Gidwani & Louise B. Russell, 2020. "Estimating Transition Probabilities from Published Evidence: A Tutorial for Decision Modelers," PharmacoEconomics, Springer, vol. 38(11), pages 1153-1164, November.
    7. Round, Jeff, 2012. "Is a QALY still a QALY at the end of life?," Journal of Health Economics, Elsevier, vol. 31(3), pages 521-527.
    8. Xinyue Dong & Xiaoning He & Jing Wu, 2022. "Cost Effectiveness of the First‐in‐Class ARNI (Sacubitril/Valsartan) for the Treatment of Essential Hypertension in a Chinese Setting," PharmacoEconomics, Springer, vol. 40(12), pages 1187-1205, December.
    9. Joseph F. Levy & Marjorie A. Rosenberg, 2019. "A Latent Class Approach to Modeling Trajectories of Health Care Cost in Pediatric Cystic Fibrosis," Medical Decision Making, , vol. 39(5), pages 593-604, July.
    10. Jisoo A Kwon & Georgina M Chambers & Fabio Luciani & Lei Zhang & Shamin Kinathil & Dennis Kim & Hla-Hla Thein & Willings Botha & Sandra Thompson & Andrew Lloyd & Lorraine Yap & Richard T Gray & Tony B, 2021. "Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis," PLOS ONE, Public Library of Science, vol. 16(2), pages 1-13, February.
    11. Qi Cao & Erik Buskens & Hans L. Hillege & Tiny Jaarsma & Maarten Postma & Douwe Postmus, 2019. "Stratified treatment recommendation or one-size-fits-all? A health economic insight based on graphical exploration," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(3), pages 475-482, April.
    12. Jorge Luis García & James J. Heckman, 2021. "Early childhood education and life‐cycle health," Health Economics, John Wiley & Sons, Ltd., vol. 30(S1), pages 119-141, November.
    13. Stephen Morris & Kurinchi S Gurusamy & Jessica Sheringham & Brian R Davidson, 2015. "Cost-Effectiveness Analysis of Endoscopic Ultrasound versus Magnetic Resonance Cholangiopancreatography in Patients with Suspected Common Bile Duct Stones," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-12, March.
    14. Tushar Srivastava & Nicholas R. Latimer & Paul Tappenden, 2021. "Estimation of Transition Probabilities for State-Transition Models: A Review of NICE Appraisals," PharmacoEconomics, Springer, vol. 39(8), pages 869-878, August.
    15. Eleanor Heather & Katherine Payne & Mark Harrison & Deborah Symmons, 2014. "Including Adverse Drug Events in Economic Evaluations of Anti-Tumour Necrosis Factor-α Drugs for Adult Rheumatoid Arthritis: A Systematic Review of Economic Decision Analytic Models," PharmacoEconomics, Springer, vol. 32(2), pages 109-134, February.
    16. Manuel Gomes & Robert Aldridge & Peter Wylie & James Bell & Owen Epstein, 2013. "Cost-Effectiveness Analysis of 3-D Computerized Tomography Colonography Versus Optical Colonoscopy for Imaging Symptomatic Gastroenterology Patients," Applied Health Economics and Health Policy, Springer, vol. 11(2), pages 107-117, April.
    17. Isaac Corro Ramos & Maureen P. M. H. Rutten-van Mölken & Maiwenn J. Al, 2013. "The Role of Value-of-Information Analysis in a Health Care Research Priority Setting," Medical Decision Making, , vol. 33(4), pages 472-489, May.
    18. Chantal Guilhaume & Delphine Saragoussi & John Cochran & Clément François & Mondher Toumi, 2010. "Modeling stroke management: a qualitative review of cost-effectiveness analyses," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(4), pages 419-426, August.
    19. Theresa Tawiah & Kristian Schultz Hansen & Frank Baiden & Jane Bruce & Mathilda Tivura & Rupert Delimini & Seeba Amengo-Etego & Daniel Chandramohan & Seth Owusu-Agyei & Jayne Webster, 2016. "Cost-Effectiveness Analysis of Test-Based versus Presumptive Treatment of Uncomplicated Malaria in Children under Five Years in an Area of High Transmission in Central Ghana," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-18, October.
    20. F. S. Mennini & Gianluca Fabiano & G. Favato & P. Sciattella & P. Bonanni & C. Pinto & A. Marcellusi, 2019. "Economic burden of HPV9-related diseases: a real-world cost analysis from Italy," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(6), pages 829-840, August.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:pharme:v:38:y:2020:i:9:d:10.1007_s40273-020-00948-w. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.