https://orcid.org/0000-0003-2861-5325
![Sample our Health and Social Care journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5938/TOC-Subject-Sample-2021-Health-Social-Care.jpg"})
Abstract
Background
Despite the use of statins, many patients with cardiovascular disease (CVD) have persistent residual risk. In a large Phase III trial (REDUCE-IT), icosapent ethyl (IPE) was shown to reduce the first occurrence of the primary composite endpoint of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or hospitalization for unstable angina.
Methods
We conducted a cost-utility analysis comparing IPE to placebo in statin-treated patients with elevated triglycerides, from a publicly funded, Canadian healthcare payer perspective, using a time-dependent Markov transition model over a 20-year time horizon. We obtained efficacy and safety data from REDUCE-IT, and costs and utilities from provincial formularies and databases, manufacturer sources, and Canadian literature sources.
Results
In the probabilistic base-case analysis, IPE was associated with an incremental cost of $12,523 and an estimated 0.29 more quality-adjusted life years (QALYs), corresponding to an incremental cost-effectiveness ratio (ICER) of $42,797/QALY gained. At a willingness-to-pay of $50,000 and $100,000/QALY gained, there is a probability of 70.4% and 98.8%, respectively, that IPE is a cost-effective strategy over placebo. The deterministic model yielded similar results. In the deterministic sensitivity analyses, the ICER varied between $31,823-$70,427/QALY gained. Scenario analyses revealed that extending the timeframe of the model to a lifetime horizon resulted in an ICER of $32,925/QALY gained.
Conclusion
IPE represents an important new treatment for the reduction of ischemic CV events in statin-treated patients with elevated triglycerides. Based on the clinical trial evidence, we found that IPE could be a cost-effective strategy for treating these patients in Canada.
Acknowledgments
The abstract of this paper was presented at the 2020 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) European Conference as a poster presentation with interim findings. The poster’s abstract was published in “Poster Abstracts” in Value in Health 23, Supplement 2; December 2020: S496. https://www.ispor.org/heor-resources/presentations-database/presentation/euro2020-3282/108314
Disclosure
JCG has received lecture fees and advisory board fees from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Merck, Novartis, Sanofi, and Servier and advisory board fees from HLS Therapeutics. RAH has received consulting fees from Acasti, Aegerion, Akcea/Ionis, Amgen, HLS Therapeutics, Novartis, Pfizer, Arrowhead Pharma, Amryt, Ultragenyx, Regeneron and Sanofi. LAL has received research funding from, has provided continuing medical education (CME) on behalf of, and/or has acted as an advisor to Amarin, Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Esperion, GSK, HLS Therapeutics, Janssen, Kowa, Lexicon, Merck, Novartis, Novo Nordisk, Pfizer, Sanofi, and Servier. The remaining authors declare no competing interests in this work.