Review on clinical strategies for managing patients with elevated Lp(a): Cost-effectiveness of Lp(a) testing and awareness of lifestyle changes via Public Health Policy in absence of targeted therapy

Abstract

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Novartis Pharma AG, Basel, Switzerland Introduction Elevated lipoprotein(a) [Lp(a)] is an inherited, independent, and causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Approximately, 20%-30% of global population has elevated Lp(a), however, Lp(a) measurement is not performed routinely in clinical practice. Purpose This review aimed to identify treatment patterns for patients with elevated Lp(a). In addition, a cost-effectiveness analysis (CEA) was performed to hypothesize that in the absence of Lp(a)-targeting therapy, broader Lp(a) testing, awareness of its additional risk and assertive management of other CV risk factors (e.g., LDL levels, BMI, Pulse pressure), may clinically and economically benefit patients and the healthcare system. Methods A systematic literature review was conducted using Embase®, MEDLINE® and MEDLINE®-In Process databases to identify the existing approaches for managing patients with ASCVD having elevated Lp(a). In addition, using a decision tree economic model and predictive risk equations from UK Biobank data, the cost effectiveness of Lp(a) screening and public policy awareness impact on other CV risk factors via lifestyle changes (e.g., diet, exercise, smoking) was assessed from a healthcare system perspective. Results Out of 6,387 retrieved publications, 45 studies were included. An average of 72%, 72%, 48% and 22% patients received lipid lowering therapies (LLTs), anti-clotting agents, anti-hypertensives and anti-diabetics, respectively. In the absence of Lp(a)-targeting therapy, the economic evaluation demonstrated dominance of the benefits of Lp(a) testing, awareness of its additional risk and resulting lifestyle modifications outweighing the costs incurred due to Lp(a) testing, for both primary and secondary prevention of ASCVD. Conclusions In the absence of a targeted therapy, investing in Lp(a) testing, awareness about elevated Lp(a) levels and optimization of modifiable risk factors via lifestyle modifications will lead to significant benefits for the healthcare system. However, this will not mitigate the Lp(a) associated CV risk, hence, there is still an unmet need for Lp(a) targeting therapies.