Colchicine for secondary prevention of cardiovascular disease, a cost per outcome analysis

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Pharmacological modulation of systemic inflammation significantly reduced cardiovascular risk among patients with coronary artery disease (CAD), beyond guideline-directed therapy. However, most anti-inflammatory therapies substantially increase the risk of infections. Low-dose (LD) Colchicine is currently the only non-lipid-lowering anti-inflammatory agent effective for secondary prevention of cardiovascular diseases that does not significantly increase infection risk. The clinical cost-effectiveness of LD Colchicine to prevent major adverse cardiovascular events (MACE) remains unexplored. Methods We calculated the annualized number needed to treat (aNNT) to prevent MACE with LD Colchicine based on the outcome data of the LoDoCo2 trial. We then analyzed the annualized cost needed to treat (aCNT) of LD Colchicine to prevent one MACE. We estimated the aCNT by multiplying the aNNT by the annual cost of therapy. LD Colchicine costs were based on 75% of the 2021 US National Average Drug Acquisition Cost listing and EU prices. Results In LoDoCo2, the aNNT for avoiding MACE with LD Colchicine was 150 (95% CI: 97-524). The annual cost of LD Colchicine is $1,889 and €352 in the US and EU, respectively. The corresponding aCNTs to prevent one MACE were 282,610$ (95% CI: 184,025$-989,137$) and 82,815€ (34,154€-184,502€) in the US and EU, respectively. Conclusion LD Colchicine might serve as an effective treatment strategy to reduce secondary cardiovascular risk among patients with CAD. The CNTs of LD Colchicine are sensitive to the drug’s pricing and thus differ between the US and the EU.