Burvill Angela, Watts Gerald F, Norman Richard, Ademi Zanfina
Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands 6009, WA, Australia (Dr Burvill).
School of Medicine, University of Western Australia, 35 Stirling Highway, Nedlands 6009, WA, Australia (Dr Watts); Department of Cardiology and Internal Medicine, Royal Perth Hospital, GPO Box X2213, Perth 6847, WA, Australia (Dr Watts).
J Clin Lipidol. 2024 Nov-Dec;18(6):e946-e956. doi: 10.1016/j.jacl.2024.08.012. Epub 2024 Aug 31.
Olpasiran and pelacarsen are gene-silencing therapies that lower lipoprotein(a). Cardiovascular outcome trials are ongoing. Mendelian randomization studies estimated clinical benefits from lipoprotein(a) lowering.
Our study estimated prices at which olpasiran and pelacarsen, in addition to standard-of-care, would be deemed cost-effective in reducing risk of recurrent coronary heart disease (CHD) events in the Australian healthcare system.
We developed a decision tree and lifetime Markov model. For olpasiran, participants had CHD and lipoprotein(a) 260 nmol/L at baseline and three-monthly injections, profiled on OCEAN(a) Outcomes trial (NCT05581303). Baseline risks of CHD, costs and utilities were obtained from published sources. Clinical trial data were used to derive reductions in lipoprotein(a) from treatment. Mendelian randomization study data were used to estimate downstream clinical benefits. Annual discounting was 5%. For pelacarsen, participants had CHD and lipoprotein(a) 226 nmol/L at baseline and one-monthly injections, profiled on Lp(a) HORIZON (NCT04023552) trial.
Olpasiran in addition to standard-of-care saved 0.87 discounted quality-adjusted life years (QALYs) per person. Olpasiran in addition to standard-of-care would be cost-effective at annual prices of AU$1867 (AU$467 per dose) at threshold AU$28,000 per QALY. Pelacarsen would be cost-effective at annual prices of AU$984 (AU$82 per dose). For incremental cost-effectiveness ratio (ICER) threshold AU$50,000 per QALY, olpasiran and pelacarsen would be cost-effective at annual prices AU$4207 and AU$2464, respectively.
This early health technology assessment model used inclusion criteria from clinical trials. Olpasiran and pelacarsen would be cost-effective if annual treatment prices were AU$1867 and AU$984, respectively, from the Australian healthcare perspective.
olpasiran和pelacarsen是降低脂蛋白(a)的基因沉默疗法。心血管结局试验正在进行中。孟德尔随机化研究估计了降低脂蛋白(a)带来的临床益处。
我们的研究估计了在澳大利亚医疗体系中，olpasiran和pelacarsen除标准治疗外，在降低复发性冠心病（CHD）事件风险方面被认为具有成本效益的价格。
我们开发了一个决策树和终身马尔可夫模型。对于olpasiran，参与者基线时患有冠心病且脂蛋白(a)≥260 nmol/L，每三个月注射一次，参照OCEAN(a) Outcomes试验（NCT05581303）。冠心病的基线风险、成本和效用值来自已发表的资料。临床试验数据用于得出治疗后脂蛋白(a)的降低情况。孟德尔随机化研究数据用于估计下游临床益处。年贴现率为5%。对于pelacarsen，参与者基线时患有冠心病且脂蛋白(a)≥226 nmol/L，每月注射一次，参照Lp(a) HORIZON（NCT04023552）试验。
olpasiran联合标准治疗每人节省0.87个贴现质量调整生命年（QALY）。olpasiran联合标准治疗在每QALY阈值为28000澳元时，年度价格为1867澳元（每剂467澳元）时具有成本效益。pelacarsen在年度价格为984澳元（每剂82澳元）时具有成本效益。对于每QALY增量成本效益比（ICER）阈值为50000澳元，olpasiran和pelacarsen分别在年度价格4207澳元和2464澳元时具有成本效益。
这个早期卫生技术评估模型采用了临床试验的纳入标准。从澳大利亚医疗保健的角度来看，如果olpasiran和pelacarsen的年度治疗价格分别为1867澳元和984澳元，那么它们将具有成本效益。
