Prioritizing icosapent ethyl provides more value for money in MACE prevention

In patients with an established cardiovascular disease, prioritizing icosapent ethyl (IPE) therapy results in significantly more value for money than primary prevention, suggests a study.

“IPE is approved for the prevention of major adverse cardiovascular events (MACE) in patients with hypertriglyceridaemia,” the authors said. “However, due to budget constraints, access to IPE will inevitably be limited to a fraction of eligible patients.”

This study estimated the number of preventable MACE when providing IPE for primary vs secondary prevention to help maximize the value for money expended. This was done by dividing the available budget by the cost needed to treat (CNT) to prevent one MACE.

CNT was calculated as the product of the number needed to treat (NNT) to prevent one MACE by therapy cost, and NNT values were determined based on the results of the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT).

The budget limit was set as the US’s threshold suggested by the Institute for Clinical and Economic Review. The authors carried out a sensitivity analysis concerning the cost of IPE in the US.

In the REDUCE-IT primary prevention cohort, the NNT to prevent one MACE over 4.9 years was 59 (95 percent confidence interval [CI], 24–∞) compared with 14 (95 percent CI, 11–21) for secondary prevention. At an annual IPE cost of $2,915, the CNT to prevent one MACE was $842,726 (95 percent CI, $342,804–∞) and $199,969 (95 percent CI, $157,118–$299,953), accordingly.

Overall, $819 million worth of IPE could prevent a total of 4,762 MACE (95 percent CI, 0–11,707) compared with 20,069 (95 percent CI, 13,379–25,541) when provided as primary vs secondary prevention therapy (p<0.001).

“The number of avoided MACE is sensitive to IPE price,” the authors noted.