Icosapent Ethyl for Primary Versus Secondary Prevention of Major Adverse Cardiovascular Events in Hypertriglyceridemia: Value for Money Analysis |
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| Authors: | Ronen Arbel Enis Aboalhasan Ariel Hammerman Joseph Azuri |
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| Affiliation: | 1. Maximizing Health Outcomes Research Lab, Sapir College, Sderot, Israel;2. Department of Pharmaceutical Technology Assessment, Clalit Health Services Headquarters, Tel-Aviv, Israel;3. Diabetes Clinic, Central District, Maccabi Healthcare Services, Tel Aviv, Israel;4. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;1. Department of Philosophy, Texas Tech University, Lubbock;2. Texas Tech University Health Sciences Center, School of Medicine, Lubbock;1. Center for Medical Training, Ehime Seikyo Hospital, Japan;2. Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Japan;1. Department of Medicine, McGill University, Montreal, Quebec, Canada;2. Division of General Internal Medicine;3. Division of Thrombosis, Center of Excellence in Thrombosis and Anticoagulation Care;4. Division of Adult Critical Care, Jewish General Hospital, Montreal, Quebec, Canada;1. Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan;2. Department of Medicine, Mackay Medical College, New Taipei City, Taiwan;3. Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan;1. Division of Pulmonary and Critical Care Medicine;2. Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn;1. Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston;2. Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar;3. Division of Cardiothoracic Surgery, Baylor School of Medicine, Houston, Tex;4. Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn;5. Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston;6. Department of Cardiovascular Medicine, University of Kentucky, Lexington;7. Division of Cardiology, Baylor School of Medicine, Houston, Tex |
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| Abstract: | ![]()
BackgroundIcosapent ethyl (IPE) is approved for the prevention of major adverse cardiovascular events (MACE) in patients with hypertriglyceridemia. However, due to budget constraints, access to IPE will inevitably be limited to a fraction of eligible patients. To help maximize value for money spent, we estimated the number of preventable MACE when providing IPE for primary versus secondary prevention.MethodsThe number of preventable MACE was estimated by dividing the available budget by the cost needed to treat (CNT) to prevent one MACE. CNT was calculated as the product of the number needed to treat (NNT) to prevent 1 MACE by therapy cost. NNT values were determined according to the Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial (REDUCE-IT) results. The budget limit was set as the United States’ threshold suggested by the Institute for Clinical and Economic Review. Sensitivity analysis was performed regarding the cost of IPE in the United States.ResultsThe NNT to prevent 1 MACE over 4.9 years in the Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial primary prevention cohort was 59 (95% confidence interval [CI]: 24-∞) versus 14 (11-21) for secondary prevention. At an annual IPE cost of $2915, the CNT to prevent 1 MACE was $842,726 (95% CI: $342,804-∞) and $199,969 ($157,118-$299,953) accordingly. A total of $819 million worth of IPE can avoid 4762 MACE (95% CI: 0-11,707) versus 20,069 (13,379-25,541), when provided as primary versus secondary prevention therapy; P < .001. The number of avoided MACE is sensitive to IPE price.ConclusionsPrioritizing IPE therapy for patients with an established cardiovascular disease may provide significantly more value for money than primary prevention. |
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| Keywords: | Hypertriglyceridemia Icosapent ethyl Major adverse cardiovascular events Outcomes research |
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