Icosapent Ethyl Cost-Effective Treatment Option for high-risk patients with hypertriglyceridemia

A recent study suggests that for high-risk patients with hypertriglyceridemia despite statin treatment, icosapent ethyl may be cost-effective at commonly accepted willingness-to-pay thresholds. The study findings were published in the JAMA Network Open on February 14, 2022.

Although REDUCE-IT demonstrated the efficacy and safety of IPE in reducing cardiovascular events among high-risk patients, some say IPE is priced too high and that patients aren't always able to receive it. Therefore, Dr William S. Weintraub and his team conducted a study to estimate the cost-effectiveness of IPE compared with standard care for high-risk patients with hypertriglyceridemia despite statin treatment.

The researchers conducted an in-trial cost-effectiveness analysis using patient-level study data from REDUCE-IT. They further performed a lifetime analysis using a microsimulation model and data from published literature. The researchers included a total of 8179 patients with hypertriglyceridemia despite stable statin therapy and randomly assigned them to IPE4 g/d (n= 4089) or placebo (n=4090) and followed them for a median of 4.9 years.

The cost of IPE was $4.16 per day after rebates using SSR Health net cost (SSR cost) and $9.28 per day with wholesale acquisition cost (WAC). The major outcome assessed was incremental quality-adjusted life-years (QALYs), total direct health care costs (2019 US dollars), and cost-effectiveness.

Key findings of the study:

• Upon analysis, the researchers found that the treatment with IPE yielded more QALYs than standard care both in the trial (3.34 vs 3.27; mean difference, 0.07) and over a lifetime projection (10.59 vs 10.35; mean difference, 0.24).
• However, upon In-trial, they noted that the total health care costs were higher with IPE using either SSR cost ($18 786) or WAC ($24 544) than with standard care ($17 273; mean difference from SSR cost, $1513; mean difference from WAC, $7271).
• They found that IPE cost $22 311 per QALY gained using SSR cost and $107 218 per QALY gained using WAC.
• Upon lifetime analysis, they found that IPE was projected to be cost-saving when using SSR cost ($195 276) compared with standard care ($197 064; mean difference, –$1788). However, they noted higher costs when using WAC ($202 830) compared with standard care (mean difference, $5766).
• Compared with standard care, they found that IPE had a 58.4% lifetime probability of costing less and being more effective when using SSR cost and an 89.4% probability of costing less than $50 000 per QALY gained when using SSR cost and a 72.5% probability of costing less than $50 000 per QALY gained when using WAC.

The authors concluded, "In this patient-level cost-effectiveness analysis of REDUCE-IT, IPE was projected to be cost-effective compared with standard care, both during the trial and over a lifetime, with an ICER below commonly accepted WTP thresholds. The findings suggest that treatment with IPE may be cost-effective among patients with high cardiovascular risk whose triglyceride levels remain high despite statin therapy."

In an accompanying editorial Dr Dariush Mozaffarian wrote, "Continued development of cost-effective medical treatments such as IPE is important. At the same time, nations will not achieve better health, more health equity, or lower health care spending until they equally emphasize and invest in public health and prevention policy to reduce lifestyle-related chronic diseases."

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DOI:10.1001/jamanetworkopen.2021.48172