School of Pharmacy, Monash University Malaysia, Selangor, Malaysia.
Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia.
Pharmacoeconomics. 2019 Oct;37(10):1277-1286. doi: 10.1007/s40273-019-00820-6.
Using non-statin lipid-modifying agents in combination with statin therapy provides additional benefits for cardiovascular disease (CVD) risk reduction, but their value for money has only been evaluated in high-income countries (HICs). Furthermore, studies mainly derive effectiveness data from a single trial or older meta-analyses.
Our study used data from the most recent network meta-analysis (NMA) and local parameters to assess the cost effectiveness of non-statin agents in statin-treated patients with a history of CVD.
A published Markov model was adopted to investigate lifetime outcomes: (1) number of recurrent CVD events prevented, (2) quality-adjusted life-years (QALYs) gained, (3) costs and (4) incremental cost-effectiveness ratios (ICERs) of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) and ezetimibe added to statin therapy. Event rates and effectiveness inputs were obtained from the NMA. Cost and utility data were gathered from published studies conducted in Thailand. A series of sensitivity analyses were performed.
Patients receiving PCSK9i and ezetimibe experienced fewer recurrent CVD events (number needed to treat [NNT] 17 and 30) and more QALYs (0.168 and 0.096 QALYs gained per person). However, under the societal perspective and at current acquisition costs in 2018, ICERs of both agents were $US1,223,995 and 27,361 per QALY gained, respectively. Based on threshold analyses, the costs need to be reduced by 97 and 85%, respectively, for PCSK9i and ezetimibe to be cost-effective.
Despite the proven effectiveness of PCSK9i and ezetimibe, the costs of these agents need to reduce to a much greater extent than in HICs to be cost-effective in Thailand.
在他汀类药物治疗的基础上联合使用非他汀类调脂药物可进一步降低心血管疾病（CVD）风险，但这些药物的性价比仅在高收入国家（HIC）得到了评估。此外，研究主要从单一试验或较旧的荟萃分析中得出有效性数据。
本研究利用最新网络荟萃分析（NMA）和当地参数的数据，评估有 CVD 病史的他汀类药物治疗患者使用非他汀类药物的成本效果。
采用已发表的马尔可夫模型来调查终生结局：（1）预防复发 CVD 事件的数量，（2）获得的质量调整生命年（QALYs），（3）成本和（4）在他汀类药物治疗基础上加用前蛋白转化酶枯草溶菌素 9 抑制剂（PCSK9i）和依折麦布的增量成本效果比（ICER）。事件发生率和有效性输入来自 NMA。成本和效用数据来自在泰国进行的已发表研究。进行了一系列敏感性分析。
接受 PCSK9i 和依折麦布治疗的患者发生的复发 CVD 事件较少（需要治疗的人数[NNT]分别为 17 和 30），获得的 QALYs 更多（每人分别增加 0.168 和 0.096 QALYs）。然而，在社会视角下，且按照 2018 年的现行采购成本，这两种药物的 ICER 分别为每获得一个 QALY 需花费 1,223,995 美元和 27,361 美元。基于阈值分析，PCSK9i 和依折麦布的成本需要分别降低 97%和 85%，才能具有成本效果。
尽管 PCSK9i 和依折麦布已被证实有效，但这些药物的成本需要比在 HIC 中降低更多的幅度，才能在泰国具有成本效果。
