PCSK9 Inhibitors: Cost-Effective for Primary Prevention?

In this Center for Pharmacoeconomics Spotlight, we examine if treating primary prevention can be cost-effective at secondary prevention prices.

• Bottom Line: Starting PCSK9 inhibitors for primary prevention in a high-risk population can be cost-effective. The cost-effectiveness is dependent on the baseline risk, the price of the drug, the effectiveness of the drug at reducing cardiovascular events, and the cost-effectiveness framework used.
• The VESALIUS-CV trial, a phase III randomized, placebo-controlled trial, recently showed that evolocumab, an injectable PCSK9 inhibitor, significantly reduced major adverse cardiovascular events in a primary prevention population. This adds to the body of clinical evidence that has previously shown that PCSK9 inhibitors significantly reduce major adverse cardiovascular events as secondary prevention. 
• Novel therapeutics for cardiovascular disease are often approved for secondary prevention before being broadened to include primary prevention over time. This “secondary first, primary later” pattern raises interesting pharmacoeconomic questions because the list price of the drug is the same for secondary and primary prevention, yet the health system costs and patient benefits are different due to the different underlying risk of cardiovascular events between the two different populations.
• Using our health economic model for cardiovascular disease, we compared the costs and outcomes for a treatment strategy that starts treatment with a PCSK9 inhibitor for primary prevention to a treatment strategy that does not use a novel therapeutic for primary prevention and instead waits to start a PCSK9 inhibitor for secondary prevention.
• The report provides cost-effectiveness estimates at different levels of baseline risk, different net price estimates, different levels of treatment effectiveness, and for different cost-effectiveness frameworks. We also detail the key drivers of economic value within the report which may be useful to companies and company builders as they plan their evidence generation activities and build their own health economic models.

Read our full report for more details and discussion.

PCSK9 Inhibitors: Cost-Effective for Primary Prevention?

Click here to read the full report.

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– Melanie Whittington, PhD, Managing Director, Head of the Center for Pharmacoeconomics