Cost-Effectiveness of Alirocumab: A Just-in-Time Analysis Based on the ODYSSEY Outcomes Trial

Area of Science:

• Cardiovascular Medicine
• Health Economics
• Pharmacoeconomics

Background:

• The ODYSSEY Outcomes trial demonstrated that adding alirocumab to statin therapy reduced major adverse cardiovascular events in patients with recent acute coronary syndrome (ACS).
• This study aimed to evaluate the cost-effectiveness of alirocumab in the U.S. healthcare system for ACS patients.

Purpose of the Study:

• To determine the cost-effectiveness of alirocumab compared to ezetimibe as an add-on therapy to statins for U.S. adults following a myocardial infarction (MI).

Main Methods:

• A decision analysis using the Cardiovascular Disease Policy Model was employed.
• Data from the ODYSSEY Outcomes trial and U.S. population health data were integrated.
• The primary outcome measure was the incremental cost-effectiveness ratio (ICER) expressed in 2018 U.S. dollars per quality-adjusted life-year (QALY) gained.

Main Results:

• Adding ezetimibe to statin therapy resulted in an ICER of $81,000 per QALY gained.
• Adding alirocumab to statin therapy had a significantly higher ICER of $308,000 per QALY gained.
• Replacing ezetimibe with alirocumab in statin-treated patients was estimated to cost $997,000 per QALY gained.

Conclusions:

• Alirocumab is not cost-effective at its original price when compared to ezetimibe for ACS patients.
• A substantial price reduction, from $14,560 to $1,974 annually, is required for alirocumab to be cost-effective relative to ezetimibe.
• Independent cost-effectiveness analyses are crucial for informing clinical and policy decisions regarding new cardiovascular drugs.