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Alirocumab not cost-effective for treating LDL cholesterol

An 86% reduction in price would be required for alirocumab to be cost-effective for lowering LDL cholesterol, according to a study published in Annals of Internal Medicine.

“The ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial included participants with a recent acute coronary syndrome. Compared with participants receiving statins alone, those receiving a statin plus alirocumab had lower rates of a composite outcome including myocardial infarction (MI), stroke, and death,” Dhruv S. Kazi, MD, MSc, MS, from Beth Israel Deaconess Medical Center, and colleagues wrote.

Alirocumab (Praluent; Sanofi, Regneron) cost $14,000 per year, which is about 100 times more than the cost of a generic statin; however, many potential savings on hospitalizations, revascularization procedures and other medical costs could make the medication cost-effective, according to the researchers.

Kazi and colleagues used the Cardiovascular Disease Policy Model to determine the cost-effectiveness of alirocumab among adults aged 40 years and older with a first MI within 1 to 12 months and a baseline LDL cholesterol level of 1.81 mmol/L or greater. They measured and compared the cost-effectiveness of a statin alone, a statin plus alirocumab and a statin plus ezetimibe in 2018 U.S. dollars per quality-adjusted life-year gained.

The researchers found that the addition of ezetimibe cost $81,000 (95% uncertainty interval [UI], 51,000-215,000) per QALY and the addition of alirocumab cost $308,000 (95% UI, 197,000-678,000) per QALY, compared with a statin alone.

When replacing ezetimibe with alirocumab, there was a cost of $997,000 (95% UI, 254,000-dominated) per QALY, compared with a statin and ezetimibe combined.

To be cost-effective in relation to ezetimibe, alirocumab would have to be significantly reduced by 86% from its original cost of $14,560 to $1,974 annually.

“We encourage other members of the academic community to become involved in evaluating the cost-effectiveness of new therapies in a timely manner,” Kazi and colleagues concluded. “We believe that this involvement may positively influence the pricing and adoption of interventions that are useful to patients, just as important clinical trials have the potential to influence clinical practice.” – by Alaina Tedesco

Disclosures: Kazi reports receiving grants from the Institute for Clinical and Economic Review. Please see study for all other authors’ relevant financial disclosures.