PCSK9 Inhibitor Evolocumab Continues to Lack Cost-Effectiveness

HealthDay News — At its current price, the addition of evolocumab to standard therapy in patients with atherosclerotic cardiovascular disease generally exceeds accepted cost-effectiveness thresholds, according to a study published in JAMA Cardiology.

Gregg C. Fonarow, MD, from the Ronald Reagan University of California in Los Angeles, and colleagues examined the cost-effectiveness of evolocumab in patients with atherosclerotic cardiovascular disease. A Markov cohort state-transition model was used, which included US population-specific demographics, risk factors, background therapy, and event rates, as well as trial-based event risk reduction.

The researchers found that evolocumab was associated with increased cost and improved quality-adjusted life-year (QALY) in the base case, using US clinical practice patients with atherosclerotic cardiovascular disease with low-density lipoprotein cholesterol levels of ≥70 mg/dL and an annual events rate of 6.4 per 100 patient-years: incremental cost $105,398; incremental QALY, 0.39, with an incremental cost effectiveness ratio (ICER) of $268,637 per QALY gained. ICERs varied from $100,193 to $488,642 per QALY in sensitivity and scenario analyses, with ICER of $413,579 per QALY for trial patient characteristics and event rate of 4.2 per 100 patient-years. In most scenarios, evolocumab treatment exceeded $150,000 per QALY.

“To achieve an ICER of $150,000 per QALY, the annual net price would need to be substantially lower ($9,669 for US clinical practice and $6,780 for trial participants), or a higher-risk population would need to be treated,” the authors write.

Several authors disclosed financial ties to pharmaceutical companies, including Amgen, which manufactures evolocumab and funded the study.

Reference

Fonarow GC, Keech AC, Pedersen TR, et al. Cost-effectiveness of evolocumab therapy for reducing cardiovascular events in patients with atherosclerotic cardiovascular disease [published online August 23, 2017]. JAMA Cardiol. doi:10.1001/jamacardio.2017.2762