MedicalResearch.com Interview with:
Dhruv S. Kazi, MD, MSc, MS
Richard A. and Susan F. Smith Center for Outcomes Research
Boston MA 02215
Cardiac Critical Care Unit
Beth Israel Deaconess Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The ODYSSEY Outcomes trial found that addition of alirocumab to statin therapy reduces the incidence of a composite of cardiovascular death, myocardial infarction, and stroke among patients with a recent history of a myocardial infarction and elevated low-density lipoprotein cholesterol.
We modeled the cost-effectiveness of alirocumab and found that, at the March 2018 price of the drug, it would not be cost-effective (either relative to statin alone or statin + ezetimibe) for this indication. We found that a large price-reduction would be required to meet the cost-effectiveness threshold of $100,000 per quality-adjusted life year. Shortly after the preliminary findings of this study were released, both manufacturers of PCSK9 inhibitors announced large price reductions in order to improve access to these drugs.
MedicalResearch.com: What should readers take away from your report?
Response: Targeting alirocumab to patients who are at a relatively high risk of coronary events would not make it cost-effective at typical willingness-to-pay thresholds unless it was also accompanied by substantial price reductions. Our experience shows that rigorous cost-effectiveness analyses can influence drug pricing if the results are available in a timely manner after the release of the clinical trial results.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: In the future, results of quality cost-effectiveness analyses should be made available in a timely manner so that cost-effectiveness and budget-impact evaluations can help stakeholders negotiate value-based pricing for drugs.
The authors have no conflicts of interest to disclose.
Kazi DS, Penko J, Coxson PG, Guzman D, Wei PC, Bibbins-Domingo K. Cost-Effectiveness of Alirocumab: A Just-in-Time Analysis Based on the ODYSSEY Outcomes Trial. Ann Intern Med. [Epub ahead of print ] doi: 10.7326/M18-1776
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