A novel cost-effectiveness model of prescription eicosapentaenoic acid extrapolated to secondary prevention of cardiovascular diseases in the United States

Abstract

Objective: Given the substantial economic and health burden of cardiovascular disease and the residual cardiovascular risk that remains despite statin therapy, adjunctive therapies are needed. The purpose of this model was to estimate the cost-effectiveness of high-purity prescription eicosapentaenoic acid (EPA) omega-3 fatty acid intervention in secondary prevention of cardiovascular diseases in statin-treated patient populations extrapolated to the US.

Methods: The deterministic model utilized inputs for cardiovascular events, costs, and utilities from published sources. Expert opinion was used when assumptions were required. The model takes the perspective of a US commercial, third-party payer with costs presented in 2014 US dollars. The model extends to 5 years and applies a 3% discount rate to costs and benefits. Sensitivity analyses were conducted to explore the influence of various input parameters on costs and outcomes.

Results: Using base case parameters, EPA-plus-statin therapy compared with statin monotherapy resulted in cost savings (total 5-year costs $29,393 vs $30,587 per person, respectively) and improved utilities (average 3.627 vs 3.575, respectively). The results were not sensitive to multiple variations in model inputs and consistently identified EPA-plus-statin therapy to be the economically dominant strategy, with both lower costs and better patient utilities over the modeled 5-year period.

Limitations: The model is only an approximation of reality and does not capture all complexities of a real-world scenario without further inputs from ongoing trials. The model may under-estimate the cost-effectiveness of EPA-plus-statin therapy because it allows only a single event per patient.

Conclusion: This novel model suggests that combining EPA with statin therapy for secondary prevention of cardiovascular disease in the US may be a cost-saving and more compelling intervention than statin monotherapy.

Keywords:

• Cardiovascular disease
• Cost-benefit analysis
• Eicosapentaenoic acid
• Cost-effectiveness

Transparency

Declaration of funding

This study was designed and sponsored by Amarin Pharma Inc., Bedminster, NJ, USA.

Declaration of financial/other relationships

JKS and CKH-L are employed by Exponent, which received grant/research support from Amarin Pharma Inc. JN is on the speakers’ bureaus of Amarin Pharma Inc., Arbor, Amgen, Kowa Pharmaceuticals America, Inc., Merck, Regeneron, and Sanofi; is a consultant to Amarin Pharma Inc.; owns stock in Amarin Pharma Inc., Amgen, Pfizer, and Regeneron; and provides advisory services to Amarin Pharma Inc. SP and PBE are employees and stock shareholders of Amarin Pharma Inc. SC is a consultant to Amarin Pharma Inc. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Editorial assistance was provided by Peloton Advantage, LLC, Parsippany, NJ, USA, and funded by Amarin Pharma Inc., Bedminster, NJ, USA.