Icosapent ethyl dominant vs. standard care in cost per QALY
PHILADELPHIA — Icosapent ethyl for patients at high CV risk conferred cost-savings in-trial and during patients’ lifetime, according to findings presented at the American Heart Association Scientific Sessions.
Using data from the REDUCE-IT trial of icosapent ethyl (Vascepa, Amarin) vs. placebo, researchers found that more than 85% of models indicated that icosapent ethyl would be cost-effective, defined as less than $50,000 per quality-adjusted life-year gained, conferring better outcomes at lower health care costs.
Moreover, treatment with icosapent ethyl, whose cost was estimated at $4.16 per day, yielded a lifetime savings of $1,800 and 11.61 QALYs compared with 11.3 shown with standard of care, resulting in a difference of 0.26 QALYs.
“This is a companion study to the REDUCE-IT study, using in-trial patient level data, allowing us to do a granular analysis,” Cardiology Today Editorial Board Member William S. Weintraub, MD, director of outcomes research at the MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, said during his presentation. “We showed that the cost of icosapent ethyl provides value, is dominant and otherwise consistent with the U.S. willingness-to-pay threshold. This remains a preliminary analysis.”
In other findings, mean costs for icosapent ethyl and placebo were $27,576 and $28,205 in-trial and $235,352 and $236,636 lifetime, respectively. According to the study, icosapent ethyl was the dominant cost-saving strategy in 70% of simulations.
Icosapent ethyl was dominant in the following REDUCE-IT subgroups: patients from the U.S., patients with diabetes, patients without diabetes, men, patients requiring secondary prevention and patients with a triglyceride level at least 150 mg/dL, Weintraub said.
Among the subgroups for whom icosapent ethyl was not dominant, the incremental cost-effectiveness ratios were $15,846 in patients outside the U.S., $40,586 in women, $63,793 in patients requiring primary prevention and $4,214 in patients with triglycerides less than 150 mg/dL, he said.
In this preliminary analysis, researchers conducted a combination cost-effectiveness analysis using treatment effects from the REDUCE-IT study, health care costs from national sources and net costs for icosapent ethyl of $4.16 per day. The model projected lifetime health care costs, CV events, survival and QALYs for REDUCE-IT eligible patients from a payer perspective.
“We have a lot more work to do until we have the final results,” Weintraub said in his presentation.” The numbers will vary from this somewhat, but the principles will remain the same. We do think icosapent ethyl is an important new therapeutic advance and should be considered in appropriate populations.” – by Scott Buzby
Weintraub WS, et al. Featured Science: Population Science. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2019; Philadelphia.
Disclosure: Weintraub reports he received research grants from Amarin and honoraria from Amarin and AstraZeneca.