Cost-effectiveness analysis of PCSK9 inhibitors in cardiovascular diseases: a systematic review

Aims: To assess the cost-effectiveness of pro-protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in cardiovascular disease. Methods and results: We performed a comprehensive search strategy in electronic databases from January 2015 to January 2019. Out of 475 articles, 16 were entered into the study. Quality-adjusted life year, life years gained (LYG), annual cost, and the incremental cost-effectiveness ratio (ICER) regarding the use of PCSK9 inhibitors were considered as the key outcomes. The cost-effectiveness threshold varied from 45,000 in Spain to 150,000 in the USA. The annual cost of PCSK9 inhibitors for studies undertaken in the USA was in the range of 14,000 to 15,000, while it was about 7000 for other developed countries. The results showed that reduction in the price of PCSK9 inhibitors changed from 20 to 88. The means of QALY were 0.65 and 0.67 in the Markov and Cardiovascular Disease Policy Modeling (CVDPM) models; also, the ICER means were 197,707 and 625,555 for the Markov and CVDPM model, respectively. Conclusion: According to the current study, the effectiveness of PCSK9 inhibitors is well documented, although all studies pointed out a higher cost of these inhibitors. Trial registration: This study was registered within the International Prospective Register of Systematic Reviews (PROSPERO) database of the University of York (CRD42018088472). © 2019, Springer Science+Business Media, LLC, part of Springer Nature