Cost-effectiveness and Budget Impact of Treatment with Evolocumab Versus Statins and Ezetimibe for Hypercholesterolemia in Spain.
Rev Esp Cardiol (Engl Ed)
; 71(12): 1027-1035, 2018 12.
Article
em En, Es
| MEDLINE
| ID: mdl-29937273
ABSTRACT
INTRODUCTION AND OBJECTIVES:
To analyze the cost-effectiveness ratio and budget impact of treatment with evolocumab (PCSK9 inhibitor) for patients in secondary prevention in the Spanish National Health System.METHODS:
A budget impact analysis, decision tree and Markov models were designed under the public health system perspective, based on the only study with morbidity and mortality data (FOURIER). The alternatives compared were evolocumab vs statins, and dual therapy with ezetimibe in 5% of the population. The measure of effectiveness used was the number of cardiovascular events avoided. Univariate and probabilistic sensitivity analyses were performed.RESULTS:
The average annual cost of patients receiving evolocumab was 11 134.78 and 393.83 for standard treatment (statins plus ezetimibe). The incremental cost-effectiveness ratio was > 600 000 per avoided cardiovascular event for both assessed outcomes (first cardiovascular death, myocardial infarction, stroke, and hospitalization due to unstable angina or coronary revascularization; second includes the first 3 events). To perform the 10-year Markov model, the average cost of standard treatment was 13 948.45 vs 471 417.37 with evolocumab. Treatment with evolocumab for patients with familial hypercholesterolemia would cost between 3 and 6.1 million euros, assuming a difference of 2.5 and 5.1 million euros with the standard treatment (2017). This difference would be between 204.3 and 1364.7 million euros (2021) for those with nonfamiliar hypercholesterolemia (secondary prevention).CONCLUSIONS:
Treatment with evolocumab is associated with a lower frequency of cardiovascular events, but is inefficient for patients suitable to receive this drug in the Spanish National Health System.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
1_ASSA2030
/
6_ODS3_enfermedades_notrasmisibles
Base de dados:
MEDLINE
Assunto principal:
Custos de Medicamentos
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Inibidores de Hidroximetilglutaril-CoA Redutases
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Ezetimiba
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Previsões
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Hipercolesterolemia
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Anticorpos Monoclonais
Tipo de estudo:
Clinical_trials
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Health_economic_evaluation
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Female
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Humans
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Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
/
Es
Revista:
Rev Esp Cardiol (Engl Ed)
Ano de publicação:
2018
Tipo de documento:
Article