PCSK9 Inhibitors: Cost-Effective for Primary Prevention?
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February 2026
PCSK9 Inhibitors: Cost-Effective for Primary Prevention?
PCSK9 inhibitors for primary prevention in a high-risk population can be cost-effective.
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?
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The Leerink Center for Pharmacoeconomics is a division of MEDACorp and an affiliate of Leerink Partners
Leerink Center for Pharmacoeconomics
– Melanie Whittington, PhD, Managing Director, Head of the Center for Pharmacoeconomics
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Disclosures
This information (including, but not limited to, prices, quotes, and statistics) has been obtained from sources that we believe reliable, but we do not represent that it is accurate or complete and it should not be relied upon as such. All information is subject to change without notice, and the information and any opinions contained herein are as of the date of this material and the Firm does not undertake any obligation to update them. The information is not an offer to sell or a solicitation to buy any product to which this information relates. Leerink Partners LLC (“Firm”), its officers, directors, employees, proprietary accounts, and affiliates may have a position, long or short, in the securities referred to in this report, and/or other related securities, and from time to time may increase or decrease the position or express a view that is contrary to that contained in this piece. The Firm’s research analysts, bankers, salespeople, and traders may provide oral or written market commentary or trading strategies that are contrary to opinions expressed, and the Firm’s market making desk may make investment decisions that are inconsistent with the opinions expressed in this document. The past performance of securities does not guarantee or predict future performance. This material does not take into account individual circumstances, objectives, or needs and is not intended as a recommendation to any particular person(s). As such, the financial instruments discussed herein may not be suitable for all investors, and investors must make their own investment decisions based upon their specific investment objectives and financial situation. This material is a marketing communication and is not and should not be construed as investment research or a research report prepared by a research analyst. Any views portrayed in this material may differ from those of the research department of Leerink Partners LLC. All information contained herein is intended solely for your own personal, informational use, and you are not permitted to reproduce, retransmit, disseminate, sell, license, distribute, republish, broadcast, post, circulate or commercially exploit the information in any manner or media without the express written consent of Leerink Partners LLC, or to use the information for any unlawful purpose. Additional information is available upon request by contacting the Editorial Department, Leerink Partners LLC, 53 State Street, 40th Floor, Boston, MA 02109. MEDACorp LLC (MEDACorp), an affiliate of Leerink Partners LLC, is a global network of independent healthcare professionals (Key Opinion Leaders and consultants) providing industry and market insights to Leerink Partners and its clients. © 2026 Leerink Partners LLC. All Rights Reserved. Member FINRA/SIPC.
Disclosures
This information (including, but not limited to, prices, quotes, and statistics) has been obtained from sources that we believe reliable, but we do not represent that it is accurate or complete and it should not be relied upon as such. All information is subject to change without notice, and the information and any opinions contained herein are as of the date of this material and the Firm does not undertake any obligation to update them. The information is not an offer to sell or a solicitation to buy any product to which this information relates. Leerink Partners LLC (“Firm”), its officers, directors, employees, proprietary accounts, and affiliates may have a position, long or short, in the securities referred to in this report, and/or other related securities, and from time to time may increase or decrease the position or express a view that is contrary to that contained in this piece. The Firm’s research analysts, bankers, salespeople, and traders may provide oral or written market commentary or trading strategies that are contrary to opinions expressed, and the Firm’s market making desk may make investment decisions that are inconsistent with the opinions expressed in this document. The past performance of securities does not guarantee or predict future performance. This material does not take into account individual circumstances, objectives, or needs and is not intended as a recommendation to any particular person(s). As such, the financial instruments discussed herein may not be suitable for all investors, and investors must make their own investment decisions based upon their specific investment objectives and financial situation. This material is a marketing communication and is not and should not be construed as investment research or a research report prepared by a research analyst. Any views portrayed in this material may differ from those of the research department of Leerink Partners LLC. All information contained herein is intended solely for your own personal, informational use, and you are not permitted to reproduce, retransmit, disseminate, sell, license, distribute, republish, broadcast, post, circulate or commercially exploit the information in any manner or media without the express written consent of Leerink Partners LLC, or to use the information for any unlawful purpose. Additional information is available upon request by contacting the Editorial Department, Leerink Partners LLC, 53 State Street, 40th Floor, Boston, MA 02109. MEDACorp LLC (MEDACorp), an affiliate of Leerink Partners LLC, is a global network of independent healthcare professionals (Key Opinion Leaders and consultants) providing industry and market insights to Leerink Partners and its clients. © 2026 Leerink Partners LLC. All Rights Reserved. Member FINRA/SIPC.
