Potential low-density lipoprotein cholesterol, cardiovascular risk and costs reduction with evolocumab: a simulation in patients with a recent myocardial infarction in Spain

Abstract

Abstract Background/Introduction FOURIER included 5,711 patients with a recent myocardial infarction (MI) and a median low-density lipoprotein cholesterol (LDL-C) of 90 mg/dL. Reducing LDL-C with evolocumab reduced the risk of major cardiovascular (CV) events by 2.1%, in absolute terms, over 2.3 years. Further research may be conducted to understand the potential benefits of evolocumab in the real world. Purpose Simulate the potential LDL-C, CV risk and costs reduction among a cohort of patients with a recent MI in Spain. Methods We considered data from a retrospective observational study using the BIG-PAC database, with anonymized electronic medical records from 1.9 million inhabitants from 7 regions in Spain. Eligible patients were adults, hospitalized for an MI (index date) between January 2015 and December 2017, treated with high-intensity lipid-lowering therapy, and with LDL-C available at baseline and at the end of follow-up (up to 18 months). For each patient, we 1) predicted their CV risk using the REACH equation; 2) simulated their LDL-C reduction based on FOURIER and assessed whether they had achieved the 2019 ESC/EAS LDL-C goals; 3) simulated their relative CV risk reduction (RRR) based on the key secondary endpoint in FOURIER and calculated their absolute CV risk reduction (ARR) over 2 years. Costs (direct and indirect), excluding medication, were computed based on achieved LDL-C categories, before and after evolocumab treatment. We conducted separate analyses for patients with LDL-C ≥100 mg/dL (current reimbursement recommendation in Spain) and LDL-C ≥70 mg/dL. Results LDL-C, CV risk and costs, before and after evolocumab treatment, are presented in Table 1. We included 1,941 patients with LDL-C ≥100 mg/dL and 3,725 patients with LDL-C ≥70 mg/dL. Median absolute LDL-C reduction was 73 mg/dL and 59 mg/dL for patients with LDL-C ≥100 mg/dL and LDL-C ≥70 mg/dL, respectively. 53% and 65% of the patients achieved LDL-C <55 mg/dL, respectively. Median ARR was 3% and 2% over 2 years, respectively. Mean costs were reduced by 1,565 EUR and 1,296 EUR, respectively. Conclusions The sub-cohort of evolocumab users with LDL-C ≥70 mg/dL had similar baseline LDL-C and CV risk than patients enrolled in FOURIER, and therefore CV risk reduction was also consistent. Evolocumab reduced LDL-C, CV risk and costs in the two sub-cohorts analysed, but the clinical and economic benefit was larger in patients with LDL-C ≥100 mg/dL. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Amgen