Rethinking cardiovascular prevention: cost-effective cholesterol lowering for statin-intolerant patients in Australia and the UK

作者：Jedidiah I Morton, Danny Liew, Gerald F. Watts, Sophia Zoungas, Stephen James Nicholls, Padraig Dixon, Zanfina Ademi · 发表于：European Journal of Preventive Cardiology · 年份：2025 · DOI：10.1093/eurjpc/zwaf114 · 被引用次数：11 · 研究领域：Lipoproteins and Cardiovascular Health、Medication Adherence and Compliance、Health Systems, Economic Evaluations, Quality of Life

AIMS: Approximately 1 in 11 people are intolerant to statins. There have been no studies evaluating the cost-effectiveness of early intervention for primary prevention of cardiovascular disease (CVD) with three non-statin drugs [ezetimibe, proprotein convertase subtilisin-kexin type 9 inhibitors (PCSK9i; inclisiran and evolocumab), and bempedoic acid]. We aimed to evaluate the cost-effectiveness of these therapies when initiated at age 40 years. METHODS AND RESULTS: We used a published microsimulation model populated with 108 statin-intolerant individuals. The model simulated the ageing of individuals from 40 to 85 years. We calculated the incremental cost-effectiveness ratio when non-statin lipid-lowering strategies were initiated at age 40 years compared to no intervention until a cardiovascular event. Incremental cost-effectiveness ratios were compared to Australian and UK cost-effectiveness thresholds of 28 000 AUD and 25 000 GBP per quality adjusted life year gained, respectively. We adopted each countries national healthcare system perspective (2022 AUD/GBP) and discounted health economic results by 5% annually for Australia and 3.5% annually for the UK. At current prices in Australia, ezetimibe was cost-effective in 34/108 (31.4%) individuals simulated; bempedoic acid in 17/108 (15.7%); bempedoic acid and ezetimibe in combination in 14/108 (13.0%); while inclisiran and evolocumab were not cost-effective in any individuals. Corresponding numbers for the UK were 98/108 (...