Evolocumab therapy not cost-effective in treating atherosclerotic CVD

The wholesale list price of evolocumab would need to be slashed by roughly one-third—from $14,253 to $9,669—for the cholesterol-lowering drug to meet generally accepted cost-effectiveness standards for treating patients with atherosclerotic cardiovascular disease (ASCVD), according to new research.

“These findings highlight the need for a comprehensive disease management approach for ASCVD that includes vigorous lifestyle changes, assiduous adherence to all guideline-directed therapies, and judicious use of new, more costly therapies,” lead researcher Gregg C. Fonarow, MD, with the division of cardiology at UCLA Medical Center, and colleagues wrote in JAMA Cardiology.

Using a simulation model of the U.S. patient population, the researchers analyzed the cost-effectiveness of adding evolocumab—a proprotein convertase subtilisin/kexin type 9 inhibitor—to standard background therapy in treating ASCVD. Compared with patients receiving only background therapy, those taking evolocumab averaged an additional 0.39 quality-adjusted life-year (QALY).

Despite that improvement, evolocumab fell well short of accepted benchmarks for value.

The World Health Organization recommends the incremental cost of a treatment be less than or equal to $150,000 per QALY gained. Evolocumab at list price costs $268,637 per QALY. Even with a 29 percent discount—an average rebate amount for branded pharmaceuticals—the incremental cost-effectiveness ratio was $165,689 per QALY.

The study's authors suggested dropping the net price of the drug or using it more selectively could enable it to meet cost-effectiveness standards.

“Targeting a subset of patients with ASCVD who are at particularly high risk for events based on clinical factors, formal risk scores, or use of a higher LDL cholesterol treatment initiation threshold for the addition of evolocumab therapy would be alternative approaches to improve value and limit expenditures,” they wrote.