Skip to main content

Advertisement

SpringerLink
Log in

Cost-Effectiveness of Evolocumab Therapy for Myocardial Infarction: The Chinese Healthcare Perspective

  • Original Article
  • Published:
Cardiovascular Drugs and Therapy Aims and scope Submit manuscript

Abstract

Purpose

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are an indispensable lipid-lowering treatment option, but their cost-effectiveness has been questioned. This study aimed to perform a health economic evaluation of evolocumab versus placebo in patients with myocardial infarction (MI) in China.

Methods

A Markov cohort state-transition model was developed in decision analysis software to estimate the incremental cost-effectiveness ratio (ICER), defined as cost per quality-adjusted life-year (QALY) saved. The simulation subjects could undergo non-fatal MI and/or stroke, or vascular or non-vascular death event. We integrated the Chinese population-specific demographics and event rates with the risk reduction of evolocumab based on the FOURIER trial and/or lowering of low-density lipoprotein cholesterol (LDL-C). Age-related change, event costs and utilities were included from published sources.

Results

At its current list price [33,748 Chinese yuan (CNY) annually per person], the ICER for evolocumab therapy was 927,713 CNY per QALY gained when integrating the FOURIER trial with absolute reduction of LDL-C. The probability of cost-effectiveness of evolocumab versus placebo was 1.96%, with a generally accepted threshold of 212,676 CNY per QALY gained. A reduction in acquisition price by approximately 70% (to less than 10,255 CNY annually) was needed to be cost-effective. Alternative scenario analyses of therapeutic benefit showed that the ICER for evolocumab in MI patients with uncontrolled familial hypercholesterolemia (FH) was 187,736 CNY per QALY gained.

Conclusion

Evolocumab in patients with MI was not cost-effective based on the price in 2019 in China; however, treatment with evolocumab was more favorable in MI patients with FH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Reed GW, Rossi JE, Cannon CP. Acute myocardial infarction. Lancet. 2017;389(10065):197–210.

    Article  Google Scholar 

  2. Yang G, Wang Y, Zeng Y, Gao GF, Liang X, Zhou M, et al. Rapid health transition in China, 1990–2010: findings from the global burden of disease study 2010. Lancet. 2013;381(9882):1987–2015.

    Article  Google Scholar 

  3. Weintraub WS, Daniels SR, Burke LE, Franklin BA, Goff DC Jr, Hayman LL, et al. Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association. Circulation. 2011;124(8):967–90.

    Article  CAS  Google Scholar 

  4. Fulcher J, O’Connell R, Voysey M, Emberson J, Blackwell L, Mihaylova B, et al. Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174 000 participants in 27 randomised trials. The Lancet. 2015;385(9976):1397–405.

    Article  Google Scholar 

  5. Saxon DR, Eckel RH. Statin intolerance: a literature review and management strategies. Prog Cardiovasc Dis. 2016;59(2):153–64.

    Article  Google Scholar 

  6. Heller DJ, Coxson PG, Penko J, Pletcher MJ, Goldman L, Odden MC, et al. Evaluating the impact and cost-effectiveness of statin use guidelines for primary prevention of coronary heart disease and stroke. Circulation. 2017;136(12):1087–98.

    Article  Google Scholar 

  7. Yang H, Li N, Zhou Y, Xiao Z, Tian H, Hu M, et al. Cost-effectiveness analysis of ezetimibe as the add-on treatment to moderate-dose Rosuvastatin versus high-dose Rosuvastatin in the secondary prevention of cardiovascular diseases in China: a Markov model analysis. Drug Des Devel Ther. 2020;14:157–65.

    Article  CAS  Google Scholar 

  8. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315–81.

    Article  Google Scholar 

  9. Alonso R, Cuevas A, Cafferata A. Diagnosis and Management of Statin Intolerance. J Atheroscler Thromb. 2019;26(3):207–15.

    Article  CAS  Google Scholar 

  10. Warden BA, Fazio S, Shapiro MD. The PCSK9 revolution: current status, controversies, and future directions. Trends Cardiovasc Med. 2020;30(3):179–85.

    Article  CAS  Google Scholar 

  11. Sabatine MS, Giugliano RP, Wiviott SD, Raal FJ, Blom DJ, Robinson J et al. Efficacy and safety of evolocumab in reducing lipids and cardiovascular events. New England J Med. 2015;372(16):1500–9.

  12. Sabatine MS, Giugliano RP, Keech AC, Honarpour N, Wiviott SD, Murphy SA et al. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. New England J Med. 2017;376(18):1713–22.

  13. Nicholls SJ, Puri R, Anderson T, Ballantyne CM, Cho L, Kastelein JJ, et al. Effect of evolocumab on progression of coronary disease in statin-treated patients: the GLAGOV randomized clinical trial. JAMA. 2016;316(22):2373–84.

    Article  CAS  Google Scholar 

  14. Sattar N, Preiss D, Robinson JG, Djedjos CS, Elliott M, Somaratne R, et al. Lipid-lowering efficacy of the PCSK9 inhibitor evolocumab (AMG 145) in patients with type 2 diabetes: a meta-analysis of individual patient data. Lancet Diabetes Endocrinol. 2016;4(5):403–10.

    Article  CAS  Google Scholar 

  15. Fonarow GC, Keech AC, Pedersen TR, Giugliano RP, Sever PS, Lindgren P, et al. Cost-effectiveness of evolocumab therapy for reducing cardiovascular events in patients with atherosclerotic cardiovascular disease. JAMA Cardiol. 2017;2(10):1069–78.

    Article  Google Scholar 

  16. Kazi DS, Moran AE, Coxson PG, Penko J, Ollendorf DA, Pearson SD, et al. Cost-effectiveness of PCSK9 inhibitor therapy in patients with heterozygous familial hypercholesterolemia or atherosclerotic cardiovascular disease. JAMA. 2016;316(7):743–53.

    Article  CAS  Google Scholar 

  17. Arrieta A, Hong JC, Khera R, Virani SS, Krumholz HM, Nasir K. Updated cost-effectiveness assessments of PCSK9 inhibitors from the perspectives of the health system and private payers. JAMA Cardiol. 2017;2(12).

  18. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the Management of Blood Cholesterol: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2019;139(25).

  19. The statistical communique of the People's Republic of China on national economic and social development in 2019. National Bureau of Statistics of China. 2020. http://www.stats.gov.cn/tjsj/zxfb/202002/t20200228_1728913.html. Accessed 16 May 2020.

  20. Wu G, Dong Z, Wu J, Li H, Wu J, Guan H. China guidelines for Pharmacoeconomic evaluations and manual. 2015th ed. Beijing: Science Press; 2015.

  21. Li J, Dreyer RP, Li X, Du X, Downing NS, Li L, et al. China patient-centered evaluative assessment of cardiac events prospective study of acute myocardial infarction: study design. Chin Med J. 2016;129(1):72–80.

    Article  Google Scholar 

  22. Dreyer RP, Zheng X, Xu X, Liu S, Li J, Ding Q, et al. Sex differences in health outcomes at one year following acute myocardial infarction: a report from the China patient-centered evaluative assessment of cardiac events prospective acute myocardial infarction study. Eur Heart J Acute Cardiovasc Care. 2019;8(3):273–82.

    Article  Google Scholar 

  23. Chen Y, Yuan Z, Lu J, Eliaschewitz FG, Lorenzatti AJ, Monsalvo ML, et al. Randomized study of evolocumab in patients with type 2 diabetes and dyslipidaemia on background statin: pre-specified analysis of the Chinese population from the BERSON clinical trial. Diabetes Obes Metab. 2019;21(6):1464–73.

    Article  CAS  Google Scholar 

  24. National Health Commission of the People’s Republic of China. China health statistics yearbook. 2019th ed. Beijing: Peking Union Medical college Press; 2020.

    Google Scholar 

  25. Wang P, Zhang B, Jin L, Liao H, Dong T. Association of various risk factors with prognosis and hospitalization cost in Chinese patients with acute myocardial infarction: a clinical analysis of 627 cases. Exp Ther Med. 2015;9(2):603–11.

    Article  Google Scholar 

  26. Yin X, Huang L, Man X, Jiang Y, Zhao X, Zhao L, et al. Inpatient cost of stroke in Beijing: a descriptive analysis. Neuroepidemiology. 2018;51(3–4):115–22.

    Article  Google Scholar 

  27. Fu Y, Zhang X, Qin S, Nie X, Shi L, Shao H, et al. Cost–effectiveness of CYP2C19 LOF-guided antiplatelet therapy in Chinese patients with acute coronary syndrome. Pharmacogenomics. 2020;21(1):33–42.

    Article  CAS  Google Scholar 

  28. Healthcare Consumer CPI of the People’s Republic of China. National Bureau of Statistics of China. 2020. http://www.stats.gov.cn/tjsj/ndsj/. Accessed 18 May 2020.

  29. Matza LS, Stewart KD, Gandra SR, Delio PR, Fenster BE, Davies EW, et al. Acute and chronic impact of cardiovascular events on health state utilities. BMC Health Serv Res. 2015;15:173.

    Article  Google Scholar 

  30. Wang X, Cai G, Wang Y, Liu R, Xi Z, Li G, et al. Comparison of long-term outcomes of young patients after a coronary event associated with familial hypercholesterolemia. Lipids Health Dis. 2019;18(1):131.

    Article  Google Scholar 

  31. Li W, Li M, Gao C, Wang X, Qi D, Liu J, et al. Impact of type 2 diabetes mellitus on recurrent myocardial infarction in China. Diab Vasc Dis Res. 2016;13(6):395–404.

    Article  CAS  Google Scholar 

  32. Zhuo X, Zhang C, Feng J, Ouyang S, Niu P, Dai Z. In-hospital, short-term and long-term adverse clinical outcomes observed in patients with type 2 diabetes mellitus vs non-diabetes mellitus following percutaneous coronary intervention: a meta-analysis including 139,774 patients. Medicine (Baltimore). 2019;98(8):e14669.

    Article  Google Scholar 

  33. Mukamal KJ, Nesto RW, Cohen MC, Muller JE, Maclure M, Sherwood JB, et al. Impact of Diabetes on Long-Term Survival After Acute Myocardial Infarction. Diabetes Care. 2001;24(8):1422–7.

    Article  CAS  Google Scholar 

  34. Inglis SC, Bebchuk J, Al-Suhaim SA, Case J, Pfeffer MA, Solomon SD, et al. Peripheral artery disease and outcomes after myocardial infarction: an individual-patient meta-analysis of 28,771 patients in CAPRICORN, EPEHESUS, OPTIMAAL and VALIANT. Int J Cardiol. 2013;168(2):1094–101.

    Article  Google Scholar 

  35. Zhan S, Tang M, Liu F, Xia P, Shu M. Wu X. ezetimibe for the prevention of cardiovascular disease and all-cause mortality events. Cochrane Database Syst Rev. 2018;11:CD012502.

    PubMed  Google Scholar 

  36. Kazi DS, Penko J, Coxson PG, Moran AE, Ollendorf DA, Tice JA, et al. Updated cost-effectiveness analysis of PCSK9 inhibitors based on the results of the FOURIER trial. JAMA. 2017;318(8):748–50.

    Article  Google Scholar 

  37. Olry de Labry Lima A, Gimeno Ballester V, Sierra Sanchez JF, Matas Hoces A, Gonzalez-Outon J, Alegre Del Rey EJ. Cost-effectiveness and budget impact of treatment with evolocumab versus statins and ezetimibe for hypercholesterolemia in Spain. Rev Esp Cardiol (Engl Ed). 2018;71(12):1027–35.

    Article  Google Scholar 

  38. Kumar R, Tonkin A, Liew D, Zomer E. The cost-effectiveness of PCSK9 inhibitors - the Australian healthcare perspective. Int J Cardiol. 2018;267:183–7.

    Article  Google Scholar 

  39. Wisloff T, Mundal LJ, Retterstol K, Igland J, Kristiansen IS. Economic evaluation of lipid lowering with PCSK9 inhibitors in patients with familial hypercholesterolemia: methodological aspects. Atherosclerosis. 2019;287:140–6.

    Article  Google Scholar 

  40. Vallejo-Vaz AJ, Robertson M, Catapano AL, Watts GF, Kastelein JJ, Packard CJ, et al. LDL-Cholesterol Lowering for the Primary Prevention of Cardiovascular Disease Among Men with Primary Elevations of LDL-Cholesterol Levels of 190 mg/dL or Above: Analyses from the WOSCOPS 5-year Randomised Trial and 20-year Observational Follow-Up. Circulation. 2017;136(20):1878–91.

    Article  CAS  Google Scholar 

  41. Taguchi I, Iimuro S, Iwata H, Takashima H, Abe M, Amiya E, et al. High-dose versus low-dose Pitavastatin in Japanese patients with stable coronary artery disease (REAL-CAD): a randomized superiority trial. Circulation. 2018;137(19):1997–2009.

    Article  CAS  Google Scholar 

  42. Kodera S, Morita H, Kiyosue A, Ando J, Takura T, Komuro I. Cost-effectiveness of PCSK9 inhibitor plus statin in patients with triple-vessel coronary artery disease in Japan. Circ J. 2018;82(10):2602–8.

    Article  CAS  Google Scholar 

  43. Stam-Slob MC, van der Graaf Y, de Boer A, Greving JP, Visseren FLJ. Cost-effectiveness of PCSK9 inhibition in addition to standard lipid-lowering therapy in patients at high risk for vascular disease. Int J Cardiol. 2018;253:148–54.

    Article  Google Scholar 

  44. Khatib R, McKee M, Shannon H, Chow C, Rangarajan S, Teo K, et al. Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data. Lancet. 2016;387(10013):61–9.

    Article  Google Scholar 

  45. Niu S, Zhao D, Zhu J, Liu J, Liu Q, Liu J, et al. The association between socioeconomic status of high-risk patients with coronary heart disease and the treatment rates of evidence-based medicine for coronary heart disease secondary prevention in China: Results from the Bridging the Gap on CHD Secondary Prevention in China (BRIG) Project. Am Heart J. 2009;157(4):709–15.e1.

    Article  Google Scholar 

  46. Jiang J, Zhou Y-J, Li J-J, Ge J-B, Feng Y-Q, Huo Y. Uncontrolled hyperlipidemia in Chinese patients who experienced acute coronary syndrome: an observational study. Ther Clin Risk Manag 2018;Volume 14:2255–2264.

  47. Schwartz GG, Steg PG, Szarek M, Bhatt DL, Bittner VA, Diaz R, et al. Alirocumab and cardiovascular outcomes after acute coronary syndrome. N Engl J Med. 2018;379(22):2097–107.

    Article  CAS  Google Scholar 

Download references

Funding

This study was supported by the National Natural Science Foundation of China (81870368 and 81370437) and Shenzhen Key Research Base of Humanities and Social Sciences.

Author information

Author notes

  1. Zhe Liang and Qi Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

    Zhe Liang, Xianliang Yan, Xuehui Zhang, Xue Chen & Quanming Zhao

  2. Department of Sleep Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

    Qi Chen & Fang Fang

  3. Shenzhen International Graduate School of Tsinghua University, Tsinghua University, Shenzhen, China

    Fei Yang

Authors
  1. Zhe Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qi Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fei Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xianliang Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xuehui Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xue Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fang Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Quanming Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Zhe Liang, Qi Chen, Fei Yang and Xianliang Yan. The first draft of the manuscript was written by Zhe Liang, and revision was performed by Fang Fang and Fei Yang. All authors approved the last version to be published, and have agreed to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Fang Fang or Quanming Zhao.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 26.8 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liang, Z., Chen, Q., Yang, F. et al. Cost-Effectiveness of Evolocumab Therapy for Myocardial Infarction: The Chinese Healthcare Perspective. Cardiovasc Drugs Ther 35, 775–785 (2021). https://doi.org/10.1007/s10557-020-07079-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10557-020-07079-6

Keywords

Search

Navigation