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The cost-effectiveness of intensive low-density lipoprotein cholesterol lowering in people with peripheral artery

Domenico R Nastasi1, Joseph V Moxon2, Richard Norman3

  • 1Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.

Journal of Vascular Surgery
|September 6, 2020
PubMed

Insights

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors significantly reduce major adverse cardiovascular and limb events in peripheral artery disease patients. Treatment is cost-effective, particularly for those with chronic limb-threatening ischemia (CLTI).

Area of Science:

  • Cardiovascular Medicine
  • Pharmacoeconomics
  • Vascular Surgery

Background:

  • Peripheral artery disease (PAD) patients face high risks of major adverse cardiovascular events (MACE) and major adverse limb events (MALE).
  • Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors effectively lower low-density lipoprotein cholesterol (LDL-C), reducing cardiovascular and limb events.
  • This study evaluates the clinical benefit and cost-effectiveness of PCSK9 inhibitors in PAD patients.

Purpose of the Study:

  • To estimate the potential reduction in MACE and MALE with PCSK9 inhibitor therapy in PAD patients.
  • To assess the cost-effectiveness of using PCSK9 inhibitors for PAD management.
  • To compare the benefits and costs in patients with intermittent claudication (IC) versus chronic limb-threatening ischemia (CLTI).

Main Methods:

  • 783 Australian PAD patients (582 IC, 201 CLTI) were prospectively enrolled.
  • LDL-C levels were measured, and MACE/MALE occurrences were tracked over a median follow-up of 2.2 years.
  • Risk reductions, numbers needed to treat (NNT), and incremental cost-effectiveness ratios (ICER) were calculated.

Main Results:

  • PCSK9 inhibition estimated to reduce MACE by 6.1% (NNT 16) and MALE by 13.7% (NNT 7) in CLTI patients.
  • For IC patients, estimated reductions were 3.2% for MACE (NNT 32) and 5.3% for MALE (NNT 19).
  • Estimated 10-year ICERs were $55,270 USD for IC and $32,800 USD for CLTI.

Conclusions:

  • PCSK9 inhibitor treatment is projected to be cost-effective for patients with CLTI.
  • The findings support the use of PCSK9 inhibitors as a valuable strategy in managing high-risk PAD patients.
  • Intensive LDL-C lowering with PCSK9 inhibitors offers significant clinical benefits and favorable economic outcomes in specific PAD populations.
Abstract

Keywords:
CholesterolCost-benefit analysisCost-effectivenessPADPCSK9 inhibitors

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