Publication:
Cost-Effectiveness Analysis of Non-Statin Lipid-Modifying Agents for Secondary Cardiovascular Disease Prevention Among Statin-Treated Patients in Thailand

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Issued Date

2019

Resource Type

Article

File Type

application/pdf

ISSN

11707690

DOI

10.1007/s40273-019-00820-6

Other identifier(s)

2-s2.0-85068326898

Rights Holder(s)

มหาวิทยาลัยศรีนครินทรวิโรฒ

Bibliographic Citation

PharmacoEconomics. Vol 37, No.10 (2019), p.1277-1286

Suggested Citation

Kongpakwattana K., Ademi Z., Chaiyasothi T., Nathisuwan S., Zomer E., Liew D., Chaiyakunapruk N. Cost-Effectiveness Analysis of Non-Statin Lipid-Modifying Agents for Secondary Cardiovascular Disease Prevention Among Statin-Treated Patients in Thailand. PharmacoEconomics. Vol 37, No.10 (2019), p.1277-1286. doi:10.1007/s40273-019-00820-6 Retrieved from: https://hdl.handle.net/20.500.14740/5146

Title

Cost-Effectiveness Analysis of Non-Statin Lipid-Modifying Agents for Secondary Cardiovascular Disease Prevention Among Statin-Treated Patients in Thailand

Author(s)

Kongpakwattana K.
 Ademi Z.
 Chaiyasothi T.
 Nathisuwan S.
 Zomer E.
 Liew D.
 Chaiyakunapruk N.

Abstract

Background: 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. Objectives: 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. Methods: 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. Results: 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. Conclusions: 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. © 2019, Springer Nature Switzerland AG.

Subject(s)

Ezetimibe
 Hydroxymethylglutaryl coenzyme A reductase inhibitor
 Proprotein convertase 9 inhibitor
 Serine proteinase inhibitor
 Unclassified drug
 Ezetimibe
 Hydroxymethylglutaryl coenzyme A reductase inhibitor
 Hypocholesterolemic agent
 PCSK9 protein, human
 Proprotein convertase 9
 Article
 Cardiovascular disease
 Cost effectiveness analysis
 Health care cost
 Human
 Meta analysis
 Network meta-analysis
 Priority journal
 Quality adjusted life year
 Secondary prevention
 Thailand
 Cardiovascular disease
 Combination drug therapy
 Cost benefit analysis
 Economics
 Markov chain
 Secondary prevention
 Anticholesteremic Agents
 Cardiovascular Diseases
 Cost-Benefit Analysis
 Drug Therapy, Combination
 Ezetimibe
 Humans
 Hydroxymethylglutaryl-CoA Reductase Inhibitors
 Markov Chains
 Network Meta-Analysis
 Proprotein Convertase 9
 Quality-Adjusted Life Years
 Secondary Prevention
 Thailand

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URI

https://hdl.handle.net/20.500.14740/5146

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Scopus: Year 1983-2021

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