Related Experiment Video
Updated: Sep 25, 2025
Differential Effects of Lipid-lowering Drugs in Modulating Morphology of Cholesterol Particles
Published on: November 10, 2017
[Cost-benefit analysis of new lipid-lowering agents]
Christopher Blaum1, Natalie Arnold1,2, Christoph Waldeyer3,4
1Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
Abstract:
Patients with atherosclerotic cardiovascular disease have a high risk for subsequent cardiovascular events despite optimal drug treatment including statins and ezetimibe. Dyslipidemia represents a central and direct cause of this, with a frequent failure to achieve the target values recommended in the guidelines. New lipid-lowering substances are increasingly becoming available for treatment of this residual risk. Due to their high cost, cost-effectiveness analyses are required in order to justify their use. Important variables when considering the cost-effectiveness of a drug are quality adjusted life years (QALY) and the incremental cost-effectiveness ratio (ICER). The lower bounds of the ICER determining the cost-effectiveness of a treatment vary between healthcare systems. The proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab are deemed to be cost-effective particularly in patients with high levels of low-density lipoprotein cholesterol (LDL-C) prior to treatment or with a high cardiovascular risk as determined by the presence of defined risk criteria. Similar considerations apply to the PCSK9 small interfering RNA (siRNA) inclisiran. Administration of bempedoic acid is deemed cost-effective especially in patients with statin intolerance. Eicosapentaenoic acid is deemed cost-effective overall, although the data with respect to the exact placebo-controlled efficacy are still inconclusive.
Insights
New lipid-lowering drugs address residual cardiovascular risk in patients with atherosclerotic cardiovascular disease. Cost-effectiveness analyses show PCSK9 inhibitors, bempedoic acid, and eicosapentaenoic acid offer value, particularly for high-risk individuals or those with statin intolerance.
Area of Science:
- Cardiology
- Pharmacoeconomics
- Internal Medicine
Background:
- Patients with atherosclerotic cardiovascular disease (ASCVD) face high risks of recurrent cardiovascular events, even with optimal statin and ezetimibe therapy.
- Dyslipidemia is a primary driver of this residual risk, often failing to meet guideline-recommended target values.
- Emerging lipid-lowering agents offer new options for managing this unmet need.
Purpose of the Study:
- To evaluate the cost-effectiveness of novel lipid-lowering therapies for managing residual cardiovascular risk in patients with ASCVD.
- To identify patient subgroups and clinical criteria that support the economic justification of these new treatments.
Main Methods:
- Analysis of cost-effectiveness using key pharmacoeconomic variables such as Quality-Adjusted Life Years (QALY) and Incremental Cost-Effectiveness Ratio (ICER).
- Review of clinical data and cost-effectiveness thresholds across different healthcare systems.
- Assessment of specific agents including proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors (alirocumab, evolocumab), PCSK9 small interfering RNA (siRNA) (inclisiran), bempedoic acid, and eicosapentaenoic acid.
Main Results:
- PCSK9 inhibitors (alirocumab, evolocumab) and PCSK9 siRNA (inclisiran) are cost-effective, especially for patients with high baseline low-density lipoprotein cholesterol (LDL-C) or significant cardiovascular risk.
- Bempedoic acid demonstrates cost-effectiveness primarily in patients with statin intolerance.
- Eicosapentaenoic acid is generally cost-effective, though conclusive placebo-controlled efficacy data are pending.
Conclusions:
- Novel lipid-lowering therapies offer valuable options for managing residual cardiovascular risk in ASCVD patients.
- Cost-effectiveness varies by drug, patient profile (e.g., baseline LDL-C, cardiovascular risk, statin tolerance), and healthcare system thresholds.
- Economic evaluations are crucial for guiding the optimal integration of these advanced treatments into clinical practice.
More Related Videos
Related Concept Videos
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
01:26Atherosclerosis III: Management
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:25Blood Studies for Cardiovascular System III: Serum Lipid Profile
Serum lipids are fats and fatty substances in the blood and are crucial for various bodily functions, including energy storage, cellular structure, and hormone production. Serum lipids consist of cholesterol, triglycerides, and phospholipids.
Cholesterol is a soft, fat-like substance found in all body cells. It is crucial for producing hormones, vitamin D, and substances that aid...
01:24Overview of Lipid Metabolism
Lipolysis: The Breakdown of Lipids:
Lipolysis is the process of breaking down lipids, particularly triglycerides, into glycerol and fatty acids. This process typically occurs in the adipose tissue and is triggered by various hormones, including glucagon and...
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT