PCSK9 inhibition, atherosclerotic cardiovascular disease, and health economics: Challenges at the crossroads

Lieven Annemans, Jane Stock and M John Chapman
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Lieven Annemans: HoGent - Hogeschool Gent = University College Ghent = Haute École de Gand
M John Chapman: CHU Pitié-Salpêtrière [AP-HP] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - SU - Sorbonne Université, SU FM - Sorbonne Université - Faculté de Médecine - SU - Sorbonne Université, Dyslipidémies, inflammation et athérosclérose dans les maladies métaboliques - INSERM - Institut National de la Santé et de la Recherche Médicale

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Abstract: Background: Improved survival after a cardiovascular event has led to an expanding patient population at very high risk of recurrent events. Reduction in low-density lipoprotein cholesterol, and thus implicitly non-high-density lipoprotein cholesterol, to guideline-recommended goals is a key tenet of secondary prevention. Yet, standard-of-care treatment with statin (with or without ezetimibe) often leaves a high risk of preventable cardiovascular events. Inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9), highly efficacious lipid-lowering treatments that confer reduction in cardiovascular events and death, clearly have a role in the personalized management of these very-high-risk patients. Given budget constraints, however, their integration into the health care pathway merits health economic considerations. Consequently, it is important to identify challenges at the crossroads of the clinical and economic dimensions. Findings and conclusion: Health economic analyses involve application of modeling scenarios integrating multiple parameters to ultimately yield values for quality-adjusted life-years and cost-effectiveness ratios. To date, these analyses have led to widely variable estimates of these benchmarks for PCSK9 inhibitors, causing confusion among stakeholders in the health care pathway. Clearly, a consensual approach to the conduct and reporting of health economic analyses involving all players, including noneconomists such as clinicians and patient advocates, is essential to bridge the gap between the clinical needs of patients and financial access to PCSK9 inhibition.

Keywords: Atherosclerotic cardiovascular disease; Disease trajectory; Health economic modeling; Innovative pharmacotherapeutics; Low-density lipoprotein cholesterol; PCSK9 inhibitors (search for similar items in EconPapers)
Date: 2019
Note: View the original document on HAL open archive server: https://hal.sorbonne-universite.fr/hal-02985707v1
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Published in Journal of clinical lipidology, 2019, 13 (5), pp.714-720. ⟨10.1016/j.jacl.2019.07.005⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-02985707

DOI: 10.1016/j.jacl.2019.07.005

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