A Systematic Review of Economic Evaluation of PCSK9 Inhibitors in Cardiovascular Disease

Abstract

Objective: To systematically review and synthesize research on the cost-effectiveness assessment of PCSK9 inhibitors. Methods: Researchers systematically searched the literature from databases including PubMed, Embase, Scopus, and Web of science from the inception to June, 24 2021. Search terms were (“PCSK9 Inhibitors” OR “proprotein convertase subtilisin/kexin type 9” OR “evolocumab” OR “alirocumab”) AND (“cardiovascular diseases”) AND (“cost-effectiveness” OR “economic evaluation” OR “cost-utility”). The search yielded a total of 296 articles, but only 16 met inclusion and exclusion criteria. This research focused on the information including population characteristics, modelling, comparative measures, quality adjusted life-year, life-year, total cost, and marginal cost-effectiveness ratios. Results: Of the 16 articles, most were conducted in patients at risk or with atherosclerotic cardiovascular diseases only (6 trials or 37.5%), followed by five trials (31.2%) in patients with familial hyperlipidemia or atherosclerotic cardiovascular diseases. Nine studies were on evolocumab (56.2%), and the remaining 7 studies were on evolocumab and alirocumab (43.8%). The drugs were compared with statins alone in 68.8% of the study. The majority of studies evaluated the cost-effectiveness with the Marko model (75.0%). Only six studies (37.5%) concluded that the use of PCSK9 inhibitors was cost-effective. Most of studies found that the drug was cost-effective in patients with hereditary hypercholesterolemia. Conclusion: The use of PCSK9 inhibitors in most patients at risk or with cardiovascular disease is not cost-effective and incurs a high cost. However, the likelihood of cost-effectiveness is higher in patients with familial hypercholesterolemia.