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Cost-effectiveness of adding ezetimibe and/or PCSK9 inhibitors to high-dose statins for secondary prevention of cardiovascular disease in Chinese adults

Published online by Cambridge University Press:  31 August 2023

Yuliang Xiang Open the ORCID record for Yuliang Xiang [Opens in a new window] ,
Lei Gan ,
Heyue Du ,
Qiukui Hao ,
Bert Aertgeerts ,
Sheyu Li  and
Ming Hu
Yuliang Xiang
Affiliation:
School of Public Health, Fudan University, Shanghai, China Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China West China School of Pharmacy, Sichuan University, Chengdu, China
Lei Gan
Affiliation:
School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
Heyue Du
Affiliation:
Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
Qiukui Hao
Affiliation:
School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
Bert Aertgeerts
Affiliation:
Department of Public Health and Primary Care and MAGIC Primary Care, Academisch Centrum voor Huisartsgeneeskunde, KU Leuven, Leuven, Belgium
Sheyu Li*
Affiliation:
Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
Ming Hu*
Affiliation:
West China School of Pharmacy, Sichuan University, Chengdu, China
*
Corresponding authors: Ming Hu and Sheyu Li; Emails: huming@scu.edu.cn; lisheyu@scu.edu.cn
Corresponding authors: Ming Hu and Sheyu Li; Emails: huming@scu.edu.cn; lisheyu@scu.edu.cn
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Abstract

Objectives

The latest international guideline recommended the add-on therapy of ezetimibe and PCSK9 inhibitors in selected people for the secondary prevention of cardiovascular diseases (CVDs). However, it remains unclear whether these regimens fit the Chinese healthcare system economically.

Methods

Based on the Chinese context, this simulation study evaluated four therapeutic strategies including the high-dose statin-only group, ezetimibe plus statin group, PCSK9 inhibitors plus statin group, and PCSK9 inhibitors plus ezetimibe plus statin group. The team developed a Markov model to estimate the incremental cost-effectiveness ratio (ICER). With each 1-yr cycle, the simulation subjects could have nonfatal cardiovascular events (stroke and/or myocardial infarction) or death (vascular or nonvascular death event) with a follow-up duration of 20 yr. Cardiovascular risk reduction was gathered from a network meta-analysis, and cost and utility data were gathered from hospital databases and published research.

Results

For Chinese adults receiving high-dose statins for secondary prevention of CVDs, the ICER was US$68,910 per quality-adjusted life year (QALY) for adding PCSK9 inhibitors, US$20,242 per QALY for adding ezetimibe, US$51,552 per QALY for adding both drugs. Given a threshold of US$37,655 (three times of Chinese GDP), the probability of cost-effectiveness is 2.9 percent for adding PCSK9 inhibitors, 53.1 percent for adding ezetimibe, and 16.8 percent for adding both drugs. To meet the cost-effectiveness, an acquisition price reduction of PCSK9 inhibitors of 33.6 percent is necessary.

Conclusion

In Chinese adults receiving high-dose statins for the secondary prevention of CVDs, adding ezetimibe is cost-effective compared to adding PCSK9 inhibitors and adding both drugs.

Keywords

secondary preventionPCSK9 inhibitorscost-effectivenessezetimibecardiovascular disease
Type
Assessment
Information
International Journal of Technology Assessment in Health Care , Volume 39 , Issue 1 , 2023 , e53
Copyright
© The Author(s), 2023. Published by Cambridge University Press

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