Low-dose colchicine cost-effective in COLCOT trial, over lifetime
A cost analysis of findings from the COLCOT trial showed that the addition of low-dose colchicine therapy to standard care after MI resulted in a 69% lifetime cost reduction compared with standard care alone.
Further, the addition of low-dose (0.5 mg once daily) colchicine to standard care resulted in a 47% average cost decrease, in the COLCOT trial ($265 vs. $502 Canadian dollars at 2 years) compared with placebo, for the endpoints of non-CV death and pneumonia, according to research presented at the virtual American College of Cardiology Scientific Session.
For lifetime use in the COLCOT population, colchicine was associated with a 69% cost reduction ($2,590 vs. $8,239 Canadian dollars at 20 years) compared with standard of care alone.
As Healio previously reported, the COLCOT trial determined that adults who received low-dose colchicine after MI were less likely to experience an ischemic CV event in the 2 years following the index event compared with adults receiving placebo.
In the present analysis, which used a multistate Markov model, the addition of colchicine also conferred and average of 2.86 more quality-adjusted life years over the patient’s lifetime, compared with placebo, resulting in a dominant incremental cost-effectiveness ratio (11.68 vs. 8.82 QALYs).
“The true cost of myocardial infarction was again the most important factor in affecting the ICER, and the ICER did remain dominant,” Michelle Samuel, MPH, PhD, postdoctoral fellow in cardiovascular epidemiology at the Montreal Heart Institute, said in her presentation. “Of course, the most important factor in the cost-effectiveness of any treatment is the cost of the treatment itself. Therefore, we vary the cost of colchicine in Canada to determine how the ICER is changed.”
The cost of colchicine in Canada is 26 cents per pill and the researchers varied the price up to $4 per pill. The incremental cost-effectiveness ratio for the drug remained dominant up to 55 cents per pill, Samuel said.
At a $50,000 willingness-to-pay threshold, colchicine remained cost-effective at about $3.50 per pill for the in-trial period, and about $4 per pill for lifetime treatment.
The cost of colchicine in the U.S. is approximately $4 to $6 per pill. In a secondary analysis of the U.S. Medicare system, researchers found that, both in-trial and lifetime, the treatment was cost effective at $4.50 per pill and remained cost-effective up $6 per pill over lifetime.
“I'm not a cost-effectiveness expert, but I do know that dominant means you save money,” Paul M. Ridker, MD, MPH, FACC, FAHA, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital and Eugene Braunwald Professor of Medicine at Harvard Medical School, said during a discussion of the trial. “I really appreciate that you went through a series of sensitivity analyses, looking at various issues. I greatly appreciate the U.S. perspective. We could have quite a political discussion about why a drug 25 cents in Canada and most of the world but is $3 to $5 per pill in the U.S. But even under that U.S. pricing, you've shown us a dominant model for lifetime and probably a dominant model for the hospitalization period.” – by Scott Buzby
Reference:
Samuel M, et al. Featured Clinical Research I. Presented at: American College of Cardiology Scientific Session; March 28-30, 2020 (virtual meeting).
Disclosures: Samuel reports no relevant financial disclosures. Ridker reports he received consultant fees/honoraria from Amgen, Civi Biopharme, Corvidia, Inflazome and Novartis and research grants from Kowa Pharmaceuticals, the NHLBI and Novartis.