Carlos-Rivera, Fernando; Guzmán-Caniupan, Jorge Antonio; Hernández-Garduño, Adolfo Gabriel; Alva-Esqueda, Mónica; Camacho-Cordero, Luis Miguel; Aubry-de Maraumont, Therese

ABSTRACT

Introduction: Cardiovascular diseases (CVDs) are the leading cause of death worldwide, imposing an enormous clinical and financial burden on healthcare systems. An elevated level of low-density lipoprotein cholesterol (LDL-C) constitutes one of the most important modifiable risk factors for CVDs. Objectives: To assess the economic and health outcomes of evolocumab (EVO) added to standard of care (SoC, high-intensity statin with/without ezetimibe) in uncontrolled high-risk adult patients with primary hypercholesterolemia and mixed dyslipidemia (PHMD) in the Mexican Institute of Social Security. Material and methods: Using a lifetime Markov model comprising seven health states with annual cycles, we compared the direct medical costs (acquisition of lipid-lowering therapies besides the costs associated with each health state and costs for a transitory event called revascularization), and life-years (LY) expected with EVO+SoC vs SoC alone. The target population was categorized into two groups: PHMD with a history of either myocardial infarction or ischemic stroke and heterozygous familial hypercholesterolemia (HeFH). Both future costs and LY were discounted at a 5% annual rate. Results: EVO+SoC had a higher acquisition cost than SoC but was also more effective. The cost per LY additionally gained by using EVO was modeled as $348,629 (MXN) in the first subpopulation and $298,148 (MXN) in patients with HeFH. The model remained robust to plausible changes in the parameters. The probability of EVO+SoC being cost-effective under a willingness to pay threshold of 3 times the gross domestic product per capita estimated for 2020 in Mexico was close to 100% in both subpopulations. Conclusions: EVO+SoC may provide a cost-effective intervention.

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