With cardiovascular diseases continually straining healthcare resources, the pursuit of cost-effective treatment options becomes a necessity, particularly in emerging economies such as China. Recent research sought to determine cost-utility comparisons of different dosing regimens of PCSK9 inhibitors, which are medications that lower cholesterol levels, when used alongside statin therapy. This exploration aims to aid in clinical decision-making and resource allocation by finding the most financially efficient and clinically effective therapies for patients with hypercholesterolemia or those at elevated cardiovascular risk.
Methodology and Approach
A decision-analytic Markov cohort model assessed the lifetime horizon cost-utility in the context of the Chinese healthcare system. The model integrated various data points, including treatment effects from a network meta-analysis, cost inputs, and statistical mortality metrics sourced from established literature and databases. Evaluations were subject to a 5% annual discount for both financial outlays and health outcomes, ensuring accurate reflections of long-term value and expenditure.
Findings and Implications
The research pinpointed evolocumab 140 mg administered every two weeks as the preeminent cost-effective choice, yielding the most favorable incremental cost-utility ratio (ICUR) relative to other PCSK9 regimens. Evolocumab led to incremental costs of $11,109.27 per quality-adjusted life year (QALY) benefits of 0.42, culminating in an ICUR of $26,217.47, which sits comfortably below China’s willingness-to-pay threshold. Meanwhile, alirocumab and tafolecimab appeared as compelling alternatives, despite showing slightly less favorable economic profiles. Conversely, other regimens demonstrated diminished economic efficiency.
– Evolocumab 140 mg Q2W prevails as the cost-effective frontrunner compared to other PCSK9 inhibitors when used with statins.
– Discount rate variations significantly influence ICUR, underlining the importance of cost consistency in such assessments.
– Probability estimates reinforce high cost-effectiveness certainty for evolocumab in comparison with statin therapy alone.
Subsequent sensitivity analyses identified the discount rate as a primary variable impacting uncertainty, indicating ICUR spans from $15,903.46 to $34,573.62 for evolocumab Q2W when compared with statins alone. Additionally, probability analysis determined a 98.9% likelihood of cost-effectiveness in using this specific PCSK9 regimen.
Healthcare decision-makers and policymakers should take note of these findings to guide the strategic allocation of limited resources within China’s health system. Emphasizing the need for cost efficiency without compromising care quality, evolocumab as part of combination therapy offers significant promise for enhancing patient outcomes economically. Recognizing the impact of discount rates on economic evaluations further stresses the urgency to standardize health economic assessments, ensuring fairness and transparency across various healthcare applications in the region.
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