Ghadimi Nashmil, Daroudi Rajabali, Shabaninejad Hosein, Goharimehr Mahshad, Khodamorzideh Davoud, Kaveh Sara
Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
Population Health Sciences Institute (PHSI), Newcastle University, Newcastle, UK.
Curr Ther Res Clin Exp. 2024 Sep 1;101:100758. doi: 10.1016/j.curtheres.2024.100758. eCollection 2024.
With the rising burden of cardiovascular disease (CVD) and the need for cost-effective interventions, evaluating the economic implications of Evolocumab becomes crucial.
This study aimed to systematically review and evaluate the cost-effectiveness of Evolocumab in adults at risk of CVD.
We performed an extensive search in Cochrane Library, EMBASE, PubMed, ProQuest, and Web of Science. The reference lists of chosen literature reviews were also examined to find suitable cost-effectiveness analyses (CEAs) of Evolocumab in patients with CVD published until March 2023. The Consolidated Health Economic Evaluation Reporting Standards statement (CHEERS) was used to assess the reporting quality. Cost-related findings were adjusted to reflect 2023 purchase power parity (PPP) values in US dollars to enable cross-study comparisons.
This systematic review comprised 16 studies, published between 2016 and 2023, mostly from the USA and China. Compliance with the CHEERS checklist was high in sections like abstracts, backgrounds, and objectives. However, areas like perspective (71.4%), time horizon (57.1%), and engagement with patients (14.3%) showed lower reporting rates. All studies evaluated the cost-effectiveness of Evolocumab in combination with other lipid-lowering treatments (LLTs). Notably, all studies employed model-based economic evaluations using a Markov cohort state-transition model, with a majority adopting a lifetime horizon. Most studies (10 cases) simultaneously reported both the Incremental Cost-Effectiveness Ratio (ICER) per Quality Adjusted Life Years (QALY) and the ICER per Life-Years Saved (LYS). Four studies exclusively reported ICER/QALY, and 2 studies solely focused on ICER/LYS. The ICER/ QALY exhibited a wide range (3,342.57 to 2,687,920.13 USD), with one study presenting as an outlier. Sensitivity analyses revealed factors influencing cost-effectiveness outcomes, including Low-Density Lipoprotein Cholesterol (LDL-C) levels, Evolocumab costs, and disease type, while several studies reported accepted thresholds for cost-effectiveness analysis.
Our systematic review concludes that Evolocumab could be a cost-effective treatment, particularly for high-risk patient groups, but this varies by disease category, risk level, and evaluation methods. Future studies should investigate the economic impact's certainty and uncertainty, and consider different countries' income levels. LDL-C levels, medication costs, and CVD types are important factors affecting cost-effectiveness analysis.
随着心血管疾病（CVD）负担的不断增加以及对具有成本效益干预措施的需求，评估依洛尤单抗的经济影响变得至关重要。
本研究旨在系统评价和评估依洛尤单抗在有心血管疾病风险的成年人中的成本效益。
我们在Cochrane图书馆、EMBASE、PubMed、ProQuest和科学网进行了广泛检索。还查阅了所选文献综述的参考文献列表，以找到截至2023年3月发表的关于依洛尤单抗在心血管疾病患者中合适的成本效益分析（CEA）。采用卫生经济评价报告标准合并声明（CHEERS）来评估报告质量。与成本相关的研究结果根据2023年美元购买力平价（PPP）值进行调整，以便进行跨研究比较。
本系统评价纳入了16项研究，发表于2016年至2023年之间，大多来自美国和中国。在摘要、背景和目的等部分，对CHEERS清单的依从性较高。然而，在视角（71.4%）、时间范围（57.1%）和患者参与度（14.3%）等方面，报告率较低。所有研究均评估了依洛尤单抗与其他降脂治疗（LLT）联合使用的成本效益。值得注意的是，所有研究都采用基于模型的经济评价，使用马尔可夫队列状态转换模型，大多数采用终身视角。大多数研究（10例）同时报告了每质量调整生命年（QALY）的增量成本效益比（ICER）和每挽救生命年（LYS）的ICER。四项研究仅报告了ICER/QALY，两项研究仅关注ICER/LYS。ICER/QALY的范围很广（3342.57至2687920.13美元），其中一项研究为异常值。敏感性分析揭示了影响成本效益结果的因素，包括低密度脂蛋白胆固醇（LDL-C）水平、依洛尤单抗成本和疾病类型，同时几项研究报告了成本效益分析的可接受阈值。
我们的系统评价得出结论，依洛尤单抗可能是一种具有成本效益的治疗方法，特别是对于高危患者群体，但这因疾病类别、风险水平和评估方法而异。未来的研究应调查经济影响的确定性和不确定性，并考虑不同国家的收入水平。LDL-C水平、药物成本和心血管疾病类型是影响成本效益分析的重要因素。
