Pharmacoeconomic rationale for alirocumab administration in acute coronary syndrome
Aim. Pharmacoeconomics evaluation of the different lipid lowering treatment options based on the published randomized clinical trials.Material and methods. Numbers needed to treat (NNT) with alirocumab+high doses statins or ezetimibe+statins for prevention of non-fatal myocardial infarction (MI), ischemic stroke, death from all causes and combined end-point were calculated based on ODYSSEY OUTCOMES and IMPROVE-IT trials. Direct medical and non-direct non-medical costs were calculated including drugs costs, hospitalizations, rehabilitation, and payments for temporary and permanent disability, GDP losses for the Russian population.Results. Both treatment options were associated with high costls for prevention of unfavorable events. Treatment with ezetimibe + statins was less expensive for prevention IM (NNT 66, costs RUR 9 507) and combined endpoint (NNT 619, costs RUR 88 821) in all populations of patients. NNT for alirocumab + statins in patients with severe hypercholesterolemia (LDL≥2,59 mmol/l) was two-fold lower than in the total population of patients, and eleven-fold lower than in patients with LDL≥1,82 and <2,59 mmol/l).Conclusion. Special diagnosis-related group for patients with atherosclerotic illness and additional risks factors is needed, given the efficacy and cost of alirocumab + statins combination in acute coronary syndrome.