Table 2.
Model base case results over a 20-year time horizon for primary and secondary cardiovascular prevention
| Cholesterol lowering strategy | Triglyceride lowering strategy | ||||
|---|---|---|---|---|---|
| Ezetimibe | Evolocumab | Alirocumab | Icosapent ethyl | Fibrate | |
| Primary prevention | |||||
| Incremental QALYs | NA | NA | NA | 0.81 | 0.63 |
| Incremental LYs | NA | NA | NA | 0.97 | 0.91 |
| Incremental costs | NA | NA | NA | 14,732 | − 10,516 |
| ICER (costs/LY) | NA | NA | NA | 15,130 | − 11,605 |
| ICER (costs/QALY) | NA | NA | NA | 18,133 | − 16,632 |
| Number needed to treat (NNT) | |||||
| Non-fatal MI | NA | NA | NA | 1.6 | 3.3 |
| Non-fatal stroke | NA | NA | NA | 5.6 | 16.3 |
| Hospitalization for unstable angina | NA | NA | NA | 4.6 | 4.4 |
| Coronary revascularization | NA | NA | NA | 1.3 | 1.2 |
| CVD death | NA | NA | NA | 3.9 | 5.0 |
| Non-CVD death | NA | NA | NA | 41.7 | 17.5 |
| Secondary prevention | |||||
| Incremental QALYs | 0.61 | 0.55 | 0.87 | 0.99 | 0.85 |
| Incremental LYs | 0.86 | 0.65 | 1.23 | 1.34 | 1.37 |
| Incremental costs | − 5,796 | 62,722 | 87,002 | 14,333 | − 8,787 |
| ICER (costs/LY) | − 6,711 | 96,243 | 71,005 | 10,695 | − 6,427 |
| ICER (costs/QALY) | − 9,555 | 114,639 | 100,532 | 14,485 | − 10,305 |
| Number needed to treat (NNT) | |||||
| Non-fatal MI | 2.7 | 1.6 | 1.6 | 1.5 | 3.5 |
| Non-fatal stroke | 8.8 | 6.4 | 6.4 | 5.3 | 21.5 |
| Hospitalization for unstable angina | 31.3 | 5.8 | 14.1 | 4.3 | 5.2 |
| Coronary revascularization | 1.7 | 1.1 | 1.4 | 1.2 | 1.3 |
| CVD death | 7.3 | 6.4 | 4.5 | 3.8 | 5.2 |
| Non-CVD death | 15.8 | 24.3 | 17.9 | 48.8 | 23.1 |
All costs are presented in Euros (€) and inflation adjusted to 2021 values. QALYs, LYs, and ICERs are displayed per person. No clinical trial data was available for ezetimibe, alirocumab, and evolocumab in the primary prevention setting. Treatment options were categorized in cholesterol lowering (ezetimibe, alirocumab, evolocumab) and triglyceride lowering (icosapent ethyl, fibrate) strategies based on the European Society of Cardiology guidelines [8]. QALY quality-adjusted life year, LY life year, ICER incremental cost-effectiveness ratio, NNT number needed to treat, CVD cardiovascular disease, MI myocardial infarct, NA not applicable.