Comparative effectiveness of lipid-lowering treatments to reduce cardiovascular disease

• Published in: Expert review of pharmacoeconomics & outcomes research Vol. 18; no. 1; p. 51
• Main Authors: Suh, Dong-Churl, Griggs, Scott K, Henderson, Emmett R, Lee, Seung-Mi, Park, Taehwan
• Format: Journal Article
• Language: English
• Published: England 02-01-2018
• Subjects: Anticholesteremic Agents - administration & dosage; Anticholesteremic Agents - economics; Anticholesteremic Agents - therapeutic use; Cardiovascular Diseases - economics; Cardiovascular Diseases - prevention & control; Cost-Benefit Analysis; Drug Costs; Drug Therapy, Combination; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hydroxymethylglutaryl-CoA Reductase Inhibitors - economics; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hypercholesterolemia - complications; Hypercholesterolemia - drug therapy; Hypercholesterolemia - economics; Proprotein Convertase 9 - antagonists & inhibitors; Treatment Outcome; Pharmacoeconomics; PCSK9 inhibitors; cost-effectiveness; lipid-lowering treatments; ezetimibe; statins
• ISSN: 1744-8379
• DOI: 10.1080/14737167.2018.1407246

The proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor is a new treatment option for patients with hypercholesterolemia. The objective of this study was to systematically review the cost-effectiveness of lipid-lowering agents.
Based on Pubmed, Embase, and Cochrane Database of Systematic Reviews, we identified 29 relevant articles. Studies found statins were cost-effective compared with placebo or no treatment in general. Atorvastatin was reported to be cost-effective against simvastatin. In most cases, rosuvastatin was more cost-effective than atorvastatin or simvastatin. Additionally, ezetimibe was considered to be cost-effective compared with no treatment for statin intolerant patients. For patients not meeting treatment goals with their statins, switching to ezetimibe plus simvastatin was consistently reported cost-effective. The cost-effectiveness of ezetimibe plus a hybrid of a statin varied by the source of clinical data and cost of ezetimibe. Finally, the cost-effectiveness of PCSK9 inhibitor plus a statin against statin monotherapy was uncertain. The PCSK9 inhibitor plus a stain was cost-ineffective compared with ezetimibe plus a statin.
Drug costs and treatment efficacy were the key drivers of the cost-effectiveness results in prior analyses. Future evaluations are warranted to reflect the decreasing drug prices and the long-term treatment effects of PCSK9 inhibitors.