Evolocumab and ezetimibe, were both proven to significantly reduce the incidence of
major adverse cardiovascular events (MACE), in type 2 diabetes patients with atherosclerotic
cardiovascular disease and low-density lipoprotein (LDL) cholesterol >70 mg/dl despite
statin therapy. Providing evolocumab for all such patients may be a significant burden
on healthcare systems. Therefore, we analyzed the treatment cost of ezetimibe versus
evolocumab to prevent 1 MACE. We extracted the number needed to treat (NNT) with evolocumab
or with ezetimibe for avoiding MACE from the published FOURIER and IMPROVE-IT trials
respectively. Drug costs were based on 2018 US prices. Sensitivity and scenario analyses
were performed to overcome variances in terms of population risk, efficacy of therapies,
and costs. In FOURIER, the 1-year NNT for avoiding MACE with evolocumab was 104 (95%
confidence intervals [CI] 66 to 235). In IMPROVE-IT, the 1-year NNT with ezetimibe
was 124 (95% CI 73 to 288). The annual cost of evolocumab and ezetimibe is $6,540
and $88, respectively. Therefore, the cost to prevent 1 MACE in the FOURIER and IMPROVE-IT
trials would have been $678,981 (95% CI $429,810 to $1,537,910,149) and $10,870 (95%
CI $6,384 to $25,322), respectively. Ezetimibe was consistently a cost-saving strategy
compared with evolocumab, in all analyses performed, except for the case where evolocumab
price is significantly reduced and the branded ezetimibe is used. In conclusion, treatment
with ezetimibe seems to be a major cost-saving strategy for preventing MACE in this
patient population.
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Article info
Publication history
Published online: January 23, 2019
Received in revised form:
January 7,
2019
Received:
October 31,
2018
Footnotes
Statement of authorship: All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Author Agreement/Declaration: We here by certify that all authors have seen and approved the final version of the manuscript being submitted.
The article is the authors' original work, has not received previous publication, and is not under consideration for publication elsewhere.
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