Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Rashid Yasemi Street, Upper than Mirdamad St, Tehran, Iran.
Heart Fail Rev. 2020 Nov;25(6):1077-1088. doi: 10.1007/s10741-019-09874-2.
To assess the cost-effectiveness of pro-protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in cardiovascular disease.
We performed a comprehensive search strategy in electronic databases from January 2015 to January 2019. Out of 475 articles, 16 were entered into the study. Quality-adjusted life year, life years gained (LYG), annual cost, and the incremental cost-effectiveness ratio (ICER) regarding the use of PCSK9 inhibitors were considered as the key outcomes. The cost-effectiveness threshold varied from $45,000 in Spain to $150,000 in the USA. The annual cost of PCSK9 inhibitors for studies undertaken in the USA was in the range of $14,000 to $15,000, while it was about $7000 for other developed countries. The results showed that reduction in the price of PCSK9 inhibitors changed from 20 to 88%. The means of QALY were 0.65 and 0.67 in the Markov and Cardiovascular Disease Policy Modeling (CVDPM) models; also, the ICER means were $197,707 and $625,555 for the Markov and CVDPM model, respectively.
According to the current study, the effectiveness of PCSK9 inhibitors is well documented, although all studies pointed out a higher cost of these inhibitors.
This study was registered within the International Prospective Register of Systematic Reviews (PROSPERO) database of the University of York (CRD42018088472).
评估前蛋白转化酶枯草溶菌素 9（PCSK9）抑制剂在心血管疾病中的成本效益。
我们在 2015 年 1 月至 2019 年 1 月的电子数据库中进行了全面的检索策略。在 475 篇文章中，有 16 篇被纳入研究。质量调整生命年、获得的生命年（LYG）、年度成本和 PCSK9 抑制剂使用的增量成本效益比（ICER）被视为关键结果。成本效益阈值因国家而异，在西班牙为 45000 美元，在美国为 150000 美元。在美国进行的研究中，PCSK9 抑制剂的年成本在 14000 至 15000 美元之间，而在其他发达国家则约为 7000 美元。结果表明，PCSK9 抑制剂的价格降低了 20%至 88%。在 Markov 和心血管疾病政策模型（CVDPM）模型中，QALY 的平均值分别为 0.65 和 0.67；在 Markov 和 CVDPM 模型中，ICER 的平均值分别为 197707 美元和 625555 美元。
根据本研究，PCSK9 抑制剂的有效性得到了很好的证明，尽管所有研究都指出了这些抑制剂的成本更高。
本研究在约克大学（University of York）国际前瞻性系统评价注册库（PROSPERO）中进行（注册号：CRD42018088472）。
