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Cost-effectiveness of Icosapent Ethyl for High-risk Patients With Hypertriglyceridemia Despite Statin Treatment.
Weintraub, William S; Bhatt, Deepak L; Zhang, Zugui; Dolman, Sarahfaye; Boden, William E; Bress, Adam P; King, Jordan B; Bellows, Brandon K; Tajeu, Gabriel S; Derington, Catherine G; Johnson, Jonathan; Andrade, Katherine; Steg, P Gabriel; Miller, Michael; Brinton, Eliot A; Jacobson, Terry A; Tardif, Jean-Claude; Ballantyne, Christie M; Kolm, Paul.
Affiliation
  • Weintraub WS; MedStar Healthcare Delivery Research Network, MedStar Health Research Institute, Washington, DC.
  • Bhatt DL; Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts.
  • Zhang Z; Institute for Research on Equity and Community Health, ChristianaCare Health System, Newark, Delaware.
  • Dolman S; MedStar Healthcare Delivery Research Network, MedStar Health Research Institute, Washington, DC.
  • Boden WE; Department of Medicine, Cardiology Section, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.
  • Bress AP; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
  • King JB; Department of Population Health Sciences, University of Utah, Salt Lake City.
  • Bellows BK; Department of Population Health Sciences, University of Utah, Salt Lake City.
  • Tajeu GS; Department of Medicine, Columbia University, New York, New York.
  • Derington CG; Health Services Administration and Policy, Temple University, Philadelphia, Pennsylvania.
  • Johnson J; Department of Population Health Sciences, University of Utah, Salt Lake City.
  • Andrade K; Health Economics and Outcomes Research, Optum, Eden Prairie, Minnesota.
  • Steg PG; Health Economics and Outcomes Research, Optum, Eden Prairie, Minnesota.
  • Miller M; Medical School of Université de Paris, Paris, France.
  • Brinton EA; Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France.
  • Jacobson TA; French Alliance for Cardiovascular Trials (FACT), INSERM U-1148, Paris, France.
  • Tardif JC; Department of Medicine, University of Maryland School of Medicine, Baltimore.
  • Ballantyne CM; Utah Lipid Center, Salt Lake City.
  • Kolm P; Office of Health Promotion and Disease Prevention, Department of Medicine, Emory University, Atlanta, Georgia.
JAMA Netw Open ; 5(2): e2148172, 2022 02 01.
Article in En | MEDLINE | ID: mdl-35157055
Importance: The Reduction of Cardiovascular Events With Icosapent Ethyl-Intervention Trial (REDUCE-IT) demonstrated the efficacy of icosapent ethyl (IPE) for high-risk patients with hypertriglyceridemia and known cardiovascular disease or diabetes and at least 1 other risk factor who were treated with statins. Objective: To estimate the cost-effectiveness of IPE compared with standard care for high-risk patients with hypertriglyceridemia despite statin treatment. Design, Setting, and Participants: An in-trial cost-effectiveness analysis was performed using patient-level study data from REDUCE-IT, and a lifetime analysis was performed using a microsimulation model and data from published literature. The study included 8179 patients with hypertriglyceridemia despite stable statin therapy recruited between November 21, 2011, and May 31, 2018. Analyses were performed from a US health care sector perspective. Statistical analysis was performed from March 1, 2018, to October 31, 2021. Interventions: Patients were randomly assigned to IPE, 4 g/d, or placebo and were followed up for a median of 4.9 years (IQR, 3.5-5.3 years). The cost of IPE was $4.16 per day after rebates using SSR Health net cost (SSR cost) and $9.28 per day with wholesale acquisition cost (WAC). Main Outcomes and Measures: Main outcomes were incremental quality-adjusted life-years (QALYs), total direct health care costs (2019 US dollars), and cost-effectiveness. Results: A total of 4089 patients (2927 men [71.6%]; median age, 64.0 years [IQR, 57.0-69.0 years]) were randomly assigned to receive IPE, and 4090 patients (2895 men [70.8%]; median age, 64.0 years [IQR, 57.0-69.0 years]) were randomly assigned to receive standard care. Treatment with IPE yielded more QALYs than standard care both in trial (3.34 vs 3.27; mean difference, 0.07 [95% CI, 0.01-0.12]) and over a lifetime projection (10.59 vs 10.35; mean difference, 0.24 [95% CI, 0.15-0.33]). In-trial, total health care costs were higher with IPE using either SSR cost ($18 786) or WAC ($24 544) than with standard care ($17 273; mean difference from SSR cost, $1513 [95% CI, $155-$2870]; mean difference from WAC, $7271 [95% CI, $5911-$8630]). Icosapent ethyl cost $22 311 per QALY gained using SSR cost and $107 218 per QALY gained using WAC. Over a lifetime, IPE was projected to be cost saving when using SSR cost ($195 276) compared with standard care ($197 064; mean difference, -$1788 [95% CI, -$9735 to $6159]) but to have higher costs when using WAC ($202 830) compared with standard care (mean difference, $5766 [95% CI, $1094-$10 438]). Compared with standard care, IPE had a 58.4% lifetime probability of costing less and being more effective when using SSR cost and an 89.4% probability of costing less than $50 000 per QALY gained when using SSR cost and a 72.5% probability of costing less than $50 000 per QALY gained when using WAC. Conclusions and Relevance: This study suggests that, both in-trial and over the lifetime, IPE offers better cardiovascular outcomes than standard care in REDUCE-IT participants at common willingness-to-pay thresholds.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Eicosapentaenoic Acid / Cost-Benefit Analysis / Hydroxymethylglutaryl-CoA Reductase Inhibitors / Hyperlipidemias Type of study: Clinical_trials / Etiology_studies / Health_economic_evaluation / Prognostic_studies / Risk_factors_studies Aspects: Patient_preference Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: JAMA Netw Open Year: 2022 Document type: Article Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Eicosapentaenoic Acid / Cost-Benefit Analysis / Hydroxymethylglutaryl-CoA Reductase Inhibitors / Hyperlipidemias Type of study: Clinical_trials / Etiology_studies / Health_economic_evaluation / Prognostic_studies / Risk_factors_studies Aspects: Patient_preference Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: JAMA Netw Open Year: 2022 Document type: Article Country of publication: