Objectives
The recent REDUCE-IT clinical trial demonstrated that in statin-treated patients with hypertriglyceridemia with established CVD and/or diabetes plus 1 risk factor that the risk of ischemic events, including cardiovascular death, was significantly reduced in those treated with IPE vs. placebo. The objective of this study was to assess the economic impact of IPE in the reduction of ischemic cardiovascular events in Canada.
Methods
A cost-utility analysis (CUA) was conducted to compare IPE to placebo for the reduction of ischemic cardiovascular events from a publicly funded Canadian healthcare payer perspective. The CUA is based on a time-dependent Markov transition model. In the CUA, patients cycled through the Markov model in one-year cycles. The Markov model is used to predict the long-term risk of major cardiovascular events through five different health states: cardiovascular event-free, non-fatal cardiovascular events composed of nonfatal MI, nonfatal stroke, coronary revascularization, or hospitalization for unstable angina, post-non-fatal cardiovascular event, death from fatal cardiovascular causes, and death from other causes for a 20-year time horizon. Costs for follow-up and monitoring, and utilities were obtained from provincial formularies and databases, manufacturer sources, and Canadian literature sources.
Results
In the probabilistic base-case analyses, treatment with IPE was associated with an incremental cost of $12,523 (SD=$1,029) and an increment of 0.29 (SD=0.08) quality-adjusted life years (QALYs) (both discounted) compared to placebo, corresponding to an ICER of $42,797 per QALY gained (SD=$15,884).
Conclusions
IPE represents an important new treatment for the reduction of ischemic cardiovascular events. Based on the clinical trial evidence, this CUA suggests that IPE is a cost-effective strategy in Canada based on the conventionally quoted thresholds of $50,000 per QALY gained.
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