Abstract 13636: Evolocumab Shows No Significant Cost-effectiveness for Myocardial Infarction in China

Abstract

Introduction: The proprotein convertase subtilisin/kexin type 9 inhibitor evolocumab has been demonstrated to reduce the incidence of cardiovascular events. This study sought to evaluate the value of evolocumab in the healthcare perspective by conducting a long-term cost-effectiveness analysis in Chinese patients with myocardial infarction (MI). Hypothesis: We assessed the hypothesis that evolocumab was inefficient for the secondary prevention of MI. Methods: A Markov cohort state-transition model was developed in decision analysis software. The model subjects could have non-fatal MI and/or stroke events, as well as die from cardiovascular disease or other causes. We integrated Chinese population specific demographics and event rates with the risk reduction of evolocumab based on large trials and meta-analysis. Age-related change, event costs and utilities were included from published sources. The model had 1-year cycle and the time horizon was 25 years. The primary outcome was the incremental cost-effectiveness ratio (ICER), defined as cost per quality-adjusted life-year (QALY) saved. Results: At its current list price (33,748 CNY annually per person), the ICER was 927,713 CNY per QALY gained. In one-way deterministic sensitivity analyses, the ICER was closely associated with the utility of cardiovascular disease event free and the cost of cardiovascular death. Probabilistic sensitivity analyses demonstrated that the probability of the cost-effectiveness of evolocumab was 1.96% at the present willingness-to-pay threshold of 212,676 CNY per QALY gained. To achieve the cost-effectiveness threshold, a net value-based price of 10,255 CNY annually would be required, which is 70% lower than the present price. Alternative scenarios analyses of treatment benefit showed in MI patients with poorly controlled familial hypercholesterolemia (FH), the ICER for evolocumab was 187,736 CNY per QALY gained, which achieved the accepted cost-effectiveness threshold. Conclusions: In conclusion, the cost-effectiveness ratio of evolocumab is less favorable in MI; However, it showed good cost-effectiveness in MI patients with poorly controlled FH in China.